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.^ 


Barclays  Official 

California 

Code  of 
Regulations 


Title  22.     Social  Security 


Complete  Title 

(continued) 


Vol.  29 


THOIVISOM 

^ 

WEST 


Barclays  Official  California  Code  of  Regulations 

425  Market  Street  •  Fourth  Floor  •  San  Francisco,  CA  94105 
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Barclays  Official  California  Code  Of  Regulations 

REVISED  edition 

This  edition  of  Barclays  Official  California  Code  of  Regulations,  revised  on  April  1,  1990,  has  been 
pubHshed  under  the  direction  of  the  California  Office  of  Administrative  Law  which  is  solely  respon- 
sible for  its  contents.  Comments  or  questions  regarding  regulations  published  in  this  edition  should 
be  addressed  to  the  State  of  Cahfornia,  Office  of  Administrative  Law,  300  Capitol  Mall,  Suite  1250, 
Sacramento,  CA  95814,  (916)  323-6225.  Errors  reported  will  be  promptly  corrected  in  subsequent 
supplements. 

OFFICIAL  PUBLICATION 

Courts  are  required  to  take  judicial  notice  of  contents  of  regulations  published  in  the  Official  Califor- 
nia Code  of  Regulations  (Gov.  Code,  §  11344.6).  Barclays  Official  California  Code  of  Regulations, 
as  revised  April  1 ,  1990,  has  been  certified  by  the  Office  of  Administrative  Law  as  the  official  publi- 
cation of  the  State  of  California  for  this  purpose  pursuant  to  title  1,  California  Code  of  Regulations, 
section  190. 

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Amendments  to  the  official  Code  are  certified  weekly  by  the  Office  of  Administrative  Law  for  publi- 
cation by  Barclays.  These  amendments,  when  certified  and  published,  become  part  of  the  Official 
California  Code  of  Regulations,  beginning  with  Register  90,  No.  14,  dated  April  7, 1990,  and  include 
all  regulations  filed  with  the  Secretary  of  State  on  or  after  April  1,  1990.  Amendment  subscriptions 
to  the  entire  revised  Code,  or  to  parts  of  it,  are  available  from  the  publisher.  For  a  descriptive  bro- 
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CODE  CITATION 

Cite  all  materials  in  the  Official  California  Code  of  Regulations  by  title  number  and  section  number. 
Example:  Title  3,  California  Code  of  Regulations,  section  432  (Short  form:  Cal.  Code  Regs.,  tit.  3, 

§  432). 

COPYRIGHT  NOTICE 

©  2008,  State  of  California. 

This  material  may  not  be  commercially  reproduced  or  sold  in  print  or  electronic  forms  without 

written  permission  of  ThomsonAVest. 


Title  22 


Social  Security 


Title  Table  of  Contents 


Title  22.     Social  Security 

Table  of  Contents 


Page 

Division  1.  Employment  Development 

Department  1 

Subdivision  1.         Director  of  Employment 

Development 3 

Division  1.  Unemployment  and  Disability 

Compensation 3 

Part  1 .  Unemployment  Compensation 3 

Chapter  1 .  General  Provisions 3 

Article  1.  Policy  and  Interpretation  3 

Article  2.  General  Definitions  3 

Chapter  2.  Administration 3 

Article  1.  Employment  Development 

Department 3 

Article  3.  California  Unemployment 

Insurance  Appeals  Board 9 

Article  4.  Interstate  and  Federal 

Cooperation  9 

Scope  or  Coverage 18 

Employment 18 

Employee 20 

Excluded  Services  , 21 

Subject  Employers 26 

Elective  Coverage   26 

Elections  for  Financing 

Unemployment  Insurance 

Coverage  31 

Financing  Unemployment 

Insurance  Coverage  for 

Public  School  Employees  33 

Financing  Unemployment 

Insurance  Coverage  for 

Local  Public  Entity 

Employees 33 

Chapter  4.  Contributions  and  Reports  34 

Article  I .  Definitions 34 

Article  2.  "Wages"  the  Basis  of  the 

Contribution  34 

Article  3.  Contribution  Rates 43 

Article  4.  Reserve  Accounts 43 


Chapter  3. 

Article  1. 

Article  1.5 

Article  2. 

Article  3. 

Article  4. 

Article  5. 

Article  6. 

Article  7. 

Article  5. 

Article  6. 

Article  7. 

Article  8. 

Article  9. 

Chapter  5. 

Article  1 . 

Article  1.5. 

Article  2. 

Article  2.4. 

Article  2.7. 

Article  3. 

Article  4. 
Article  5. 

Chapter  5.5. 
Chapter  5.6. 
Chapter  5.7. 

Chapter  6. 

Chapter  7. 

Chapter  8. 

Chapter  9. 
Article  1. 
Article  2. 

Chapter  9.5. 

Chapter  10. 


Page 

Transfer  of  Reserve 

Accounts  45 

Records,  Reports  and 

Contribution  Payments 46 

Payment  of  Reported 

Contributions  53 

Assessments 53 

Reliinds  and  Overpayments  54 

Unemployment  Compensation 

Benefits  54 

Eligibility  and 

DisqualificaUons 54 

Retraining  Benefits  94 

Computation  (Amount  and 

Duration) 94 

Work  Sharing  Unemployment 
Insurance  Benefits  94 

Irregular  or  Infrequent  Wage 
Payments 96.3 

Filing,  Determination,  and 

Payment  of  Unemployment 

Compensafion  Benefit 

Claims 96.4 

Overpayments  104.2 

Rights  of  Trainees 106 

Unemployment  Compensation  for 

State  Employees 106 

Unemployment  Compensation  for 
County  Employees 107 

Unemployment  Compensation  for 

State  Higher  Education 

Employees 107 

Financial  Provisions  107 

Collections  107 

Hearing  Procedure 109 

Pubhc  Employment  Offices 109 

Job  Services  109 

Appeals 110.1 

Employment  for  Older  Workers 113 

Violations  113 


Page  i 


(7-18-2008) 


Title  Table  of  Contents 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


Page 

Part  2.  Disability  Compensation 114      Division  2. 

Chapter  1 .  General  Provisions 114  Chapter 

Chapter  2.  Disability  Benefits 116 


Page 

Work  Incentive  Programs 132.5 

Employment  Preparation 

Program 1 32.5 


Article  1.  Eligibility 116 

Article  2.  Computation  (Amount  and 

Duration)  118 

Article  3.  Determinations  of  Continuing 

Eligibility 118 

Article  4.           Filing,  Determination  and 
Payment  of  Disability 
Benefit  Claims 118.2 

Article  5.  Overpayments  123 

Article  6.  Rights  of  Trainees 123 

Article  7.  Rights  of  Industrially 

Disabled  Persons 124 

Chapter  3.  Additional  Benefits 124 

Chapter  3.5.         Prorated  Benefits  124 

Chapter  4.  Contributions 124 

Chapter  5.  Financial  Provisions  124 

Article  1.  Disability  Fund  124 

Article  2.  Disability  Administration 

Account  124 

Article  3.  Disability  Benefit  Payment 

Account  124 

Article  4.  Extended  Liability  Account  125 

Article  5.  Investments  in  Buildings 125 

Chapter  6.  Voluntary  Plans 125 

Chapter  7.  Family  Temporary  Disability 

Insurance 131 

Part  3.  Extended  Unemployment 

Compensation  1 32.5 


Chapter  1. 


General  Provisions 132.5 


Chapter  2.  Extended  Duration  Benefits 132.5 

Article  1.  Eligibility  and 

Disqualifications 132.5 

Article  2.  Computation  (Amount  and 

Duration)  132.5 

Article  3.           Filing,  Determination,  and 
Payment  of  Extended 
Duration  Benefit  Claims  132.5 

Article  4.  Reserve  Accounts 132.5 

Article  5.  Overpayments  132.5 


Chapter  4. 


Retraining  Benefits  132.5 


Article  1.  Job  Search  Assistance 132.5 

Article  2.  Pilot  Payment  Component 132.5 

Division  2.5.  Withholding  Tax  on  Wages  132.6 

Chapter  1 .  General  Provisions 1 32.6 

Chapter  2.  Withholding  and  Payment  of  Tax 148 

Chapter  3.  Withholding  Exemptions 153 

Chapter  4.  Reports,  Returns,  and 

Statements 1 54 

Chapter  5.  Collections  1 55 

Division  3.  Employment  Services  Programs  155 

Parti.  Employment  and  Employability 

Services 1 55 

Chapter  1.  General  Provisions  and 

Definitions  1 55 

Chapter  1.5.         Employment  Training  Panel   155 

Article  1.  General  Provisions 155 

Article  2.  Proposal  Process 158.1 

Article  4.  Program  Operations 158.1 1 

Chapter  2.  Job  Training  Partnership  Act 

Complaints 158.15 

Article  1.  General  Provisions 158.15 

Article  2.  Service  Delivery  Area 

Complaint  Procedures 158.16 

Article  3.            Procedures  for  Requests  for 
EDD  Review  or  Appeals  of 
Service  Delivery  Area 
Decisions 158.18 

Article  4.  Appeals  of  FDD-Level 

Decisions 158.19 

Chapter  2.5.  Youth  Employment  and 

Development  158.20 

Chapter  2.7.         California  Work-Site  Education 

and  Training  Act 158.21 

Subdivision  2.         California  Unemployment 

Insurance  Appeals  Board  159 

Chapter  1 .  General 1 59 

Chapter  2.  Field  Operations 163 

Chapter  3.  Appellate  Operations  170 

Chapter  4.            California  Unemployment 
Insurance  Appeals  Board — 
Conflict  of  Interest  Code 172.2 


Page  ii 


(7-18-2008) 


Title  22 


Social  Security 

Page 

California  Department  of  Part  2. 

Aging  173 

California  Department  of  Aging — 

Conflict  of  Interest  Code 173      Subdivision  1. 

Title  III  Programs— Definitions 173  Chapter  1. 

Title  III  Programs — PSAs  and  Article  1 

AAAs  174.1 

Article  2. 
Designation  of  PSAs  and 

AAAs  174.1  A    •  1    o 

Article  3. 

AAAs  General  Article  4. 

Responsibilities 174.4 

Area  Plans 174.5  ^, 

Chapter  2. 

AAA  Procurement  Procedures  ...   174.9 

Grievance  Process  174.12  Chapter  3 

Sanctions  174.13 

Title  III  Programs— Program  and  Chapter  4. 

Service  Provider  Requirements 174.15 

General  Requirements  for 

Programs  and  Service  Subdivision  2. 

Providers  174.15 

Chapter  1. 
Information  and  Assistance   174.15 

Multipurpose  Senior  Centers 174.18  p.  ^ 

Legal  Assistance 174.20 

Title  III  C-Elderly  Chapter  2. 1 . 

Nutrition  Program   174.20 

Title  III  Programs— State  Subdivision  4. 

Hearings 174.24 

Office  of  the  State  Long-Term  Chapter  1 . 

Care  Ombudsman 174.27 

Long-Term  Care  Ombudsman  Chapter  2. 

Program  Provisions  174.27 

Chapter  2.5. 
Ombudsman  Duties 174.27 

Violations  and  Enforcement 174.27 

Planning  and  Service  Areas  Chapter  3. 

(PSAs)  and  Area  Agencies  on  Subchapter  1. 

Aging  (AAAs) 174.28 

Title  III  Programs— State  Subchapter  2. 

Hearings 174.28  Article  1. 

Department  of  Social  Services — 

Department  of  Health  Article  2. 

Services 175 

Department  of  Social  Article  3. 

Services — Manuals  of  Subchapter  3. 

Policies  and  Procedures 175 


Title  Table  of  Contents 

Page 

Health  and  Welfare  Agency — 

Department  of  Health 

Services  Regulations   175 

Health  and  Welfare  Agency 175 

Displaced  Homemakers 

Programs 1 75 

Definitions 175 

Priority  for  Services  for 

Eligible  Participants 176 

Stipends  for  Job  Training 176 

Sliding  Fee  Schedule: 

Workshops 177 

Health  and  Welfare  Agency — 

Conflict  of  Interest  Code 177 

Safe  Drinking  Water  and  Toxic 
Enforcement  Act  of  1986  178 

Hazardous  Substance  Cleanup 

Arbitration  Panel  Hearing 

Regulafions 201 

Administration  201 

Department  of  Social  Services — 
Conflict  of  Interest  Code 201 

Department  of  Health  Services — 
Conflict  of  Interest  Code 202 

Department  of  Health  Services 

Audits  and  Appeals 202 

Insdtutions  and  Boarding  Homes 

for  Persons  Aged  1 6  and  Above 206 

General  Provisions  and 

Definitions  206 

Licensing  Agencies 206 

Maternity  Home  Care  Program: 
Pregnancy  Freedom  of  Choice 

Act 206 

Adoptions  Program  Regulations 210 

Adoptions  Program 

Terminology 210 

General  Requirements 213 

Correction,  Alteration, 

Translation  and  Reading  of 

Forms  213 

Recruitment — Agency 

Adoptions  217 

Staffing  Requirements  219 

Administrative 

Requirements 220 


Division  1.8. 

Chapter  1. 

Chapter  2. 
Chapter  3. 

Article  1. 

Article  2. 

Article  3. 
Article  4. 
Arficle  5. 
Article  6. 

Chapter  4. 
Article  1. 

ArUcle  2. 
Article  3. 
Arficle  4. 
Arficle  5. 

Chapter  5. 

Chapter  6. 

Arficle  1. 

Arficle  2. 
Arficle  3. 

Chapter  4. 
Arficle  7. 
Division  2. 

Part  1. 


Page  iii 


(7-18-2008) 


Title  Table  of  Contents BARCLAYS  CALIFORNIA 

Page 

Article  1.  Administration  of  Public  and 

Private  Agencies 220 

Article  1.1.        Unavailability  of  Verifying 

Documents 221 

Article  2.  Content  of  Case  Record 221 

Article  3.  Procedures  for  Post- Adoption 

Services  222 

Article  4.  Private  Adoption  Agency 

Reimbursement  Program 225 

Subchapter  4.       Procedures  for 

Independent  Adoptions 226 

Article  1 .  Agency  Responsibility  226 

Article  2.  Placement  for  Independent 

Adoption  229 

Article  3.  Prerequisites  to  Consent 232 

Article  3.1.        Freeing  a  Child  for 

Adoption  238 

Article  4.  Accepting  Consent 239 

Article  5.  Finahzation  of  Adoption  240 

Article  6.  Procedures  in  Denials  and 

Commitments 241 

Subchapters.       Procedures  for  Agency 

Adoptions  242 

Article  1 .  Assessment  of  the  Child 242 

Article  2.  Freeing  a  Child  for 

Adoption  243 

Article  3.  Services  for  the  Birth 

Parents  244 

Article  4.  Prerequisites  to  Accepting  a 

Relinquishment 248 

Article  5.  Accepting  the 

Relinquishment 249 

Article  6.  Accepting  the  Statement  of 

Understanding  252 

Article  7.  Revocation  of 

Relinquishment 260.2 

Article  8.  Filing  of  Relinquishment 260.4 

Article  9.  Rescission  of 

Relinquishment 260.4 

Article  10.  Application  to  Adopt 260.6 

Article  11.  Assessment  of  the  Applicant  260.8 

Article  12.  Adoptive  Placement 260.12 

Article  13.  Completing  the  Adoption  260.16 

Article  14.  Grievance  Review  260.18 

Subchapter  6.       Procedures  for 

Intercountry  Adoptions 260.20 


CODE  OF  REGULATIONS  Title  22 

Page 

Article  1.  General  and  Administrative 

Requirements 260.20 

Article  2.  Application  for  the 

Placement  of  a  Child  for 

Adoption  260.21 

Article  3.  Assessment  of  the  Applicant  ....  260.21 

Article  4.  Assessment  of  the  Child 260.24 

Article  5.  Background  Information  on 

the  Birth  Parents  260.25 

Article  6.  Placement  260.25 

Article  7.  Supervision  of  Adoptive 

Placement  260.26 

Article  8.  Intercountry  Adoption  Court 

Report 260.27 

Subchapter  7.  Adoption  Assistance 
Program/ Aid  for  the 
Adoption  of  Children 

(AAP/AAC)   260.28 

Article  1.  AAP  Case  Initiation 260.28 

Article  2.  AAP  Eligibility 

Requirements 260.29 

Article  3.  AAP  Payments 260.30 

Article  4.  Adoption  Assistance  Program 

Agreement 260.32 

Article  5.  AAP  Payment  Authorization 260.33 

Article  6.  AAP  Reassessment  260.33 

Article  7.  AAP  Overpayments 260.34 

Article  8.  Notice  of  Action  260.35 

Article  9.  Continuation  of  Aid  for  the 

Adoption  of  Children  (AAC)  ....  260.35 

Article  10.         Documentation  of  AAP 

Ehgibility 260.35 

Article  1 1 .  Reimbursement  for 

Nonrecurring  Adoption 

Expenses  260.36 

Subchapter  8.       Adoption  of  Children  with 

Indian  Heritage  260.36(a) 

Article  1 .  Additional  Agency 

Requirements  for  Adoption 

of  Children  with  Indian 

Heritage  260.36(a) 

Article  2.  Certification  of  Degree  of 

Indian  Blood  (CDIB),  Tribal 
Membership  Eligibility,  and/ 
or  Tribal  Enrollment  260.36(a) 

Article  3.  Background  Information  260.37 

Article  4.           Information  to  Parents  of  a 
Child  with  Indian  Heritage 
Regarding  Provisions  of  the 
ICWA    260.37 


Page  iv 


(7-18-2008) 


Title  22 


Social  Security 

Page 

Freeing  the  Indian  Child  for  Article  1. 

Adoption  260.38  Article  2. 

Information  Transmitted  to  Article  3 

Applicants  in  Agency 

Adoptions  260.39 

Article  4. 
Placement  and  Supervision  in 
an  Agency  Adoption  260.39  Article  5. 

Information  Transmitted  to 

r,  ,  „•  Article  6. 

Petitioners  in  an 

Independent  Adoption   260.39 

Article  V 
Information  Transmitted  to 

the  Adoptee 260.40  Article  8. 

Interstate  Compact  on  the  Chapter  5. 

Placement  of  Children 

(ICPC) 260.40  A     •   ,     1 

^  '  Article  I. 

Definitions  and  Conditions 260.40  .    ■  i    ^ 

Article  2. 

Relinquishment  Adoptions  260.40  a  t'  1    ^ 

Independent  Adoptions 260.41 

Minimum  Standards  for  Facilities  Chapter  6. 

for  Children  260.43 

Day  Nurseries  260.43 

^.  c      J     1    r  Article  1. 

Minimum  Standards  for 

Residential  Care  Homes  for  Article  2. 

Adults 260.43 

^           .      ^       *  Article  3. 

Continuing  Care  Agreements   260.43 

Article  4. 
Preventive  Medical  Services 260.43 

California  Health  Services 

Corps 260.43  Article  6. 

Definitions 260.43  Article  7. 

Eligibility 260.44  Article  8. 

Application 261  Article  9. 

Personnel 261 

Charges  and  Reimbursements  262  *  _■  i    i  r* 

^  Article  10. 

Recipient  Rights  263  ^^.^j^  ^ ^ 

Rural  Health  Services  Article  12. 

Development  Projects 263 

Chapter  8. 
Definitions 263 

Applicants 264 

Types  of  Assistance 264  Article  1 . 

Application  for  Financial  Article  2. 

Assistance  264  Article  3. 

Charges  and  Reimbursements  265  Article  4 

Recipient  Rights  265  Article  5. 

Victims  of  Sexual  Assault 266  Chanter  9 

Sickle  Cell  Screening  Program 266  Article  1 . 


Title  Table  of  Contents 

Page 

Definitions 266 

Scope  of  the  Regulations 266 

Approval  of  a  Sickle  Cell 

Screening  Program 266 

Services  266 

Sickle  Cell  Screening 

Laboratory  Services    266 

Certification  of  Sickle  Cell 

Counselors 266 

Participant  Rights 267 

Community  Relationship 267 

Assistance  to  Primary  Care 

Clinics 267 

Definitions 267 

Eligibility  for  Grant 268 

Administration  of  the  Grants 

Program  269 

California  Special  Supplemental 

Food  Program  for  Women,  Infants 

and  Children 269 

Definitions 269 

Certification  of 

Participants 272 

Nondiscrimination  275 

Fair  Hearing  Procedures  for 
Participants 276 

Supplemental  Foods  276 

Nutrition  Education 276.1 

Food  Delivery  System  276.1 

Selection  of  Local  Agencies 288.3 

Administrative  Appeal  of 

Departmental  Decisions 

Affecting  Local  Agencies  289 

Investigations 290 

Penalties 290 

Records  and  Reports  290 

Human  Immunodeficiency  Virus 
(HIV)  Testing  of  Inmates  in 
Correctional  Facilities  291 

Definitions 291 

Procedures 292 

Appeals  Process  295 

Testing  Procedures 298.1 

Counseling  298.2 

Tuberculosis  Examination 298.3 

Application 298.3 


Article  5. 

Article  6. 

Article  7. 

Article  8. 

Article  9. 

Subchapter  9 

Article  1. 

Article  2. 

Article  3. 

Chapter  4. 


Subchapter  2, 

Chapter  5. 

Chapter  6. 

Subdivision  6. 

Chapter  1. 

Article  1. 

Article  2. 

Article  3. 

Article  4. 

Article  5. 

Article  6. 

Chapter  2. 

Article  1. 
Article  2. 
Article  3. 
Article  4. 

Article  5. 
Article  6. 

Chapter  3. 

Chapter  4. 


Page  V 


(7-18-2008) 


Title  Table  of  Contents BARCLAYS  CALIFORNIA 

Page 

Article  2.  Definitions 298.3 

Article  3.  Tuberculosis  Examination 298.3 

Article  4.  Admission  to  School 298.3 

Article  5.  Records 298.4 

Article  6.  Reporting 299 

Article  7.  Exclusion  from  School 299 

Subdivision  7.         California  Children's  Services  299 

Chapter  1.  Definitions  299 

Chapter  2.  Administration 302 

Article  1.  General  Provisions 302 

Article  5.  Records  and  Reports  302.1 

Chapter  3.  Application  Process 302.1 

Article  1.  General  Provisions 302.1 

Chapter  4.  Medical  Eligibility 302.2 

Article  1.  General  Provisions 302.2 

Chapter  5.  Residential  Eligibility 302.7 

Article  1.  General  Provisions 302.7 

Chapter  6.            Financial  Eligibility 302.8 

Article  2.           Other  Provisions 302.8 

Article  3.           CCS  Legal  Agreement  302.8 

Article  4.           Annual  Enrollment  Fee  302.9 

Article  5.  Annual  EnrollmentFee 

Collection  302.9 

Chapter  7.  Program  Benefits  302.9 

Article  3.  Diagnostic  Services 302.9 

Article  4.  Treatment  Services 302.10 

Article  6.  Authorization  for  Services  302.10 

Chapter  9.  Professional  Medical  Care 

Providers 302.10 

Article  1.  General  Provisions 302.10 

Article  3.  Physicians  302.10 

Article  4.  Other  Health  Care 

Professionals 302.11 

Chapter  10.  Hospital  Providers 302.  ii 

Article  1.  General  Provisions 302.11 

Article  4.  Special  Hospital  303 

Chapter  13.           Resolution  of  Complaints  and 
Appeals  by  CCS  Chents  or 
Applicants 303 

Article  1.  Notice  of  Action  303 

Article  2.  Designated  CCS  Agency 304 

Article  3.  CCS  Fair  Hearing 304 


CODE  OF  REGULATIONS  Title  22 

Page 

Chapter  14.  Other  CCS  Programs   304.3 

Article  1.  Immunization  Adverse 

Reaction  Fund  304.3 

Division  2.1 .        Department  of  Rehabilitation  305 

Chapter  1 .  Programs  for  the  Blind    305 

Chapter  2.  Vocational  Rehabilitation 

Programs  305 

Division  3.  Healtli  Care  Services 307 

Subdivision  1.         California  Medical  Assistance 

Program 307 

Chapter  1.  Introduction  307 

Chapter  2.  Determination  of  Medi-Cal 

Eligibility  and  Share  of  Cost  308 

Article  1.  Definitions,  Abbreviations 

and  Program  Terms  308 

Article  2.  Administration 317 

Article  3.           County  of  Responsibility  for 
Determination  of  Medi-Cal 
Eligibihty 320 

Article  4.  Beneficiary  Application 

Process  322 

Article  5.  Medi-Cal  Programs 336.7 

Article  6.  Institutional  Status  341 

Article  7.  Alienage,  Citizenship  and 

Residence 342 

Article  8.  Responsible  Relatives  and 

Unit  Determination  348 

Article  9.  Property  350.3 

Article  10.  Income  362.2 

Article  1 1 .  Maintenance  Need  374 

Article  12.  Share  of  Cost  375 

Article  13.  Period  of  Eligibility 378 

Article  14.         Medi-Cal  Card  Use  and 

Issuance  379 

Article  15.         Other  Health  Care  Coverage 
and  Medicare  Buy-In 
Coverage  382 

Article  16.         Overpayments,  Fraud  and 

Improper  Utilization  386 

Article  17.         Dialysis  Medi-Cal  Program 386.3 

Article  18.         State  Administrative 

Hearings 389 

Article  19.         Medi-Cal  Estate  Recovery  390 

Chapter  2.5.         Third  Party  Liability 390 

Article  1.  Definitions 390 


Page  vi 


(7-18-2008) 


Title  22 


Social  Security 
Page 

Estate  Recovery 392  Article  4. 

Health  Care  Services 392.4 

Application  and  Enrollment 392.4 

General  Provisions 394.1 1  .    ■  ,    ^ 

Article  5. 

Provider  Audit  Appeals  396.3 

Skilled  Nursing  Facility  and  Article  6. 

Intermediate  Care  Facility  Article  7. 

Certification  Appeals 
Procedure 402 

Definitions 403  Chapter  4.5. 

Standards  for  Participation  424 

Scope  and  Duration  of 

Benefits  436.3  Article  2. 

Scope  and  Duration  of  Article  3. 

Supplemental  Schedule  of 

Benefits  466.1 

Eligibility  for  Payment 466.1  Chapter  5. 

Payment  for  Services  and 

Supplies  471  Article  2. 

Hospital  Inpatient  Services  Article  3. 

Reimbursement  Section 516.4(d)(7) 

„     „.       r^  Article  4. 

Conflict  of  Interest 516.19 

Article  5. 
Early  and  Periodic 

Article  6 
Screening,  Diagnosis,  and 

Treatment  Program  517  Chapter  5.5. 

Pilot  and  Demonstration 

Projects 517 

Chapter  6. 

Prepaid  Health  Plans 517 

General  Provisions 517  Article  1. 

T^  e-  ■.■  .,^  Article  2. 

Definitions 517 

Article  3. 

Operational  Requirements 520 

Article  4. 

Marketing,  Enrollment  and 

Disenrollment 528  *  _•  i    c 

Article  5. 

Applications,  Contracts  and  Article  6 

Public  Hearings 530 

Chapter  7. 
Conflict  of  Interest 532 

Emergency  Services  Claims  Article  1. 

^''P^''' '''-  Article! 

Two-Plan  Model  Managed  Care 
Program 538 

Article  3. 
General  Provisions 538 

Definitions 538  „,  „ 

Chapter  8. 

Maximum  Enrollment  Levels  538.2 


Title  Table  of  Contents 

Page 

Prepaid  Health  Plan  and 

Primary  Care  Case 

Management  Plan  Enrollment 

Growth  During  the 

Transition  Period 538.2 

Two-Plan  Model 

Requirements 538.2(a) 

Operational  Requirements 538.2(c) 

Marketing,  Enrollment, 

Assignment,  and 

Disenrollment 538.2(j) 

Geographic  Managed  Care 

Program 538.2(r) 

General  Provisions 538.2(r) 

Operational  Requirements 538.3 

Marketing,  Enrollment, 

Assignment,  and 

Disenrollment 538.6 

Adult  Day  Health  Care 538.10 

General  Provisions 538.10 

Definitions 538.10 

Eligibility,  Participation 

and  Discharge 539 

Services  and  Standards 541 

Administration 546 

Payment  of  Services  551 

Indians  and  Indian  Health 

Service  Facilities  in  Medi-Cal 

Managed  Care  Programs 552 

Primary  Care  Case  Management 

Plans  552.3 

General  Provisions 552.3 

Definitions 552.4 

Operational  Requirements 556 

Marketing,  Enrollment  and 
Disenrollment 565 

Apphcation  and  Proposal 568.1 

Conflict  of  Interest 568.3 

Construction/Renovation 
Reimbursement  Program 568.4 

Definitions 568.4 

Eligibility  for  Construction/ 
Renovation  Reimbursement 
Program  570 

Standards  for  Supplemental 
Reimbursement 570 

California  Partnership  for  Long- 
Term  Care 571 


Article  2. 

Chapter  3. 
Article  1. 
Article  1.3. 
Article  1.5. 
Article  1.6. 


Article  2. 
Article  3. 
Article  4. 

Article  5. 


Article  6. 

Article  7. 

Article  7.5 

Article  8. 

Article  10. 

Chapter  3.5. 

Chapter  4. 
Article  I. 
Article  2. 
Article  3. 
Article  4. 

Article  5. 

Article  6. 
Article  7. 

Chapter  4.1. 

Article  1. 
Article  2. 
Article  3. 


Page  vii 


(7-18-2008) 


Title  Table  of  Contents BARCLAYS  CALIFORNIA 

Page 

Article  1 .  Definitions 571 

Article  2.  Conditions  of  Issuer 

Participation  578 

Article  3.           Benefits  and  Provisions  for 
Partnership  Policies  and 
Certificates  584 

Article  4.  Premium  Provisions 589 

Article  5.  Care  Management  Provider 

Agency  Standards 590 

Article  6.  Issuer  Reporting 

Requirements  and  Audit 

Information 592 

Chapter  11.  Drug  Formulary  and  Medical 

Supplies  Listing  596 

Article  1 .  Medical  Supplies  and  Medi- 

Cal  Drug  Formulary   596 

Division  4.  Environmental  Health 599 

Chapter  1 .  Introduction  599 

Article  1.  Definitions 599 

Chapter  2.  Regulations  for  the 

Implementation  of  the 

California  Environmental 

Quality  Act 599 

Article  1.  General  Requirements  and 

Categorical  Exemptions 599 

Chapter  3.  Water  Recychng  Criteria 600 

Article  1.  Definitions 600 

Article  2.  Sources  of  Recycled  Water 602.1 

Article  3.  Uses  of  Recycled  Water 602.1 

Article  4.  Use  Area  Requirements  602.2 

Article  5.  Dual  Plumbed  Recycled  Water 

Systems  602.4 

Article  5.1.        Groundwater  Recharge 602.4 

Article  5.5.        Other  Methods  of  Treatment  602.5 

Article  6.  Sampling  and  Analysis 602.5 

Article  7.  Engineering  Report  and 

Operational  Requirements 602.5 

Article  8.  General  Requirements  of 

Design 603 

Article  9.           Alternative  Reliability 
Requirements  for  Uses 
Permitting  Primary 
Effluent 603 


CODE  OF  REGULATIONS  Title  22 

Page 

Article  10.          Alternative  Reliability 
Requirements  for  Uses 
Requiring  Oxidized, 
Disinfected  Wastewater  or 
Oxidized,  Coagulated, 
Clarified,  Filtered, 
Disinfected  Wastewater  603 

Article  11.         Other  Methods  of  Treatment  604 

Chapter  4.  Water  Treatment  Devices  604 

Article  1 .  Definitions 604 

Article  2.  Certification  Requirements 605 

Article  3.  Application  Requirements 605 

Article  4.  Testing  and  Testing 

Protocols  606 

Article  5.  Product  Labeling  and  Data 

Sheet  Requirements 609 

Article  6.  Fees  609 

Chapter  12.  Safe  Drinking  Water  Project 

Funding  609 

Article  1.  Definitions 609 

Article  2.  Financing  Criteria 610.2 

Article  3.  Disadvantaged  Communities 610.4 

Article  4.  Application  Process 610.4 

Article  5.           Information  to  Be  Submitted 
Prior  to  Execution  of  the 
Funding  Agreement 610.6 

Article  6.  Design  and  Construction  610.6 

Article  7.  Claims  and  Loan  Repayments 610.6 

Article  8.  Consohdation  Projects  610.6(a) 

Chapter  13.  Operator  Certification 610.6(a) 

Article  1.  Definitions 610.6(a) 

Article  2.  Operator  Certification 

Grades 610.7 

Article  3.  Operator  Examination 

Criteria  and  AppUcations 610.8 

Article  4.  Operator  Certification 

Criteria  and  Applications 610.9 

Article  5.           Certification  Renewals, 
Delinquent  Renewals  and 
Fees  610.12 

Chapter  14.  Water  Permits   610.13 

Article  1.  Applications 610.13 

Article  3.  State  Small  Water  Systems 610.14 

Article  4.  Local  Primacy  Delegation 61 1 

Chapter  15.  Domestic  Water  Quality  and 

Monitoring  Regulations 615 

Article  1.  Definitions 615 


Page  viii 


(7-18-2008) 


Title  22 


Social  Security 
Page 

General  Requirements 616.4  Article  4. 

Primary  Standards — 

Bacteriological  Quality 616.7 

Article  5 
Primary  Standards — Inorganic 

Chemicals  616.10  Article  6. 

Trihalomethanes  616.10(c)  Article  7. 

Radioactivity  616.10(c)  Article  8. 

Primary  Standards — Organic 

Chemicals  616.12  Chapter  ]  7. 

Best  Available  Technologies  Article  1. 

(BAT)    616.15 

Treatment  Techniques 616.17  Article  2. 

Secondary  Drinking  Water 

Standards 616.18 

Special  Monitoring  .    .  .    ^ 

J^     .  ,   ,-     *  Article  3. 

Requirements  tor 

Unregulated  Chemicals  616.20  Article  4. 

Notification  of  Water  Article  5. 

Consumers  and  the  Article  6. 

Department 616.21  .    .  ,    ^ 

^  Article  7. 

Records,  Reporting  and 

Recordkeeping 616.29  Article  8. 

Consumer  Confidence  Report  . . .  616.30 

Chapter  17.5. 

Disinfectant  Residuals,  Article  1 

Disinfection  Byproducts,  and 

Disinfection  Byproduct 

Precursors 616.34  Article  2. 

General  Requirements  and 

T-N  c-  •^-  ^1^  -,.  Article  3. 

Defmitions 616.34 

Maximum  Contaminant  Levels  a    •  i    /i 

for  Disinfection  Byproducts 

and  Maximum  Residual 

Disinfectant  Levels  616.34  Article  5. 

Monitoring  Requirements  616.39  Article  6. 

CompUance  Requirements  616.41 

Treatment  Technique  for  Article  7 

Control  of  Disinfection 
Byproduct  Precursors 

(DBPP) 616.42 

Article  8. 
Reporting  and  Recordkeeping 

Requirements 616.44 

California  Waterworks  Article  9. 

Standards 616.45 

Definitions 616.45  Chapter  18. 

Waivers  and  Alternatives 616.46  Article  1. 

Permit  Requirements 616.46  Chant  r  1 9 

Water  Sources  619 


Title  Table  of  Contents 

Page 

Materials  and  Installation 

of  Water  Mains  and 

Appurtenances 620 

Disinfection  Requirements  621 

Distribution  Reservoirs 622 

Additives  622 

Distribution  System 

Operation 622. l 

Surface  Water  Treatment 622.3 

General  Requirements  and 

Definitions 622.3 

Treatment  Requirements, 

Watershed  Protection 

Requirements,  and 

Performance  Standards 622.5 

Monitoring  Requirements 622.6(b) 

Design  Standards  622.6(b)(3) 

Operation 622.6(b)(3) 

Reporting 622.6(b)(4) 

Watershed  Sanitary 

Surveys 622.6(b)(5) 

Public  Notification 622.6(b)(5) 

Lead  and  Copper  622.6(b)(6) 

General  Requirements  and 

Definitions 622.6(b)(6) 

Requirements  According  to 

System  Size 622.6(e) 

Monitoring  for  Lead  and 

Copper  622.6(0 

Water  Quality  Parameter 

(WQP)  Monitoring 622.6(i) 

Corrosion  Control 622.6(1) 

Source  Water  Requirements 

for  Action  Level 

Exceedances 622.6(k) 

Public  Education  Program  for 

Lead  Action  Level 

Exceedances 622.6(1) 

Lead  Service  Line 

Requirements  for  Action 

Level  Exceedances 622.6(o) 

Reporting  and 

Recordkeeping 622.6(p) 

Drinking  Water  Additives 622.6(q) 

Requirements 622.6(q) 

Certification  of  Environmental 
Laboratories 622.6(q) 


Article  2. 

Ardcle  3. 

Article  4. 

Article  4.5 

Article  5. 

Article  5.5 

Article  12. 

Article  14. 

Article  16. 

Article  17. 

Article  18. 

Article  19. 

Article  20. 

Chapter  15.5. 

Article  1. 
Article  2. 


Article  3. 
Article  4. 
Article  5. 


Article  6. 

Chapter  16. 

Article  1. 
Article  1.5. 
Article  2. 
Article  3. 


Page  ix 


(7-18-2008) 


Title  Table  of  Contents BARCLAYS  CALIFORNIA 

Page 

Article  1.  Definitions 622.6(q) 

Article  2.  Certification  and  Amendment 

Process  622.7 

Article  3.  Application  Process 622.8 

Article  4.  Site  Visits 622.8 

Article  5.  Performance  Evaluation 

Testing  Process  622.9 

Article  6.  Required  Test  Methods 622.9 

Article  7.  Laboratory  and  Equipment 622.10 

Article  8.  Quality  Assurance 

Documents  622.10 

Article  9.  Laboratory  Personnel  622.10 

Article  10.         Notification  and  Reporting 622.1 1 

Article  IL         Reciprocity  Agreements 622.12 

Article  12.         Subgroups  for  Fields  of 

Testing  622.12 

Article  13.         Trade  Secrets  622.14 

Article  14.         Sale  or  Transfer  of 

Ownership  of  a  Laboratory 622.14 

Article  16.         National  Environmental 
Laboratory  Accreditation 
Program  (NELAP) 622.15 

Chapter  20.  Public  Swimming  Pools 622.15 

Article  1.  Definitions  and  Scope 622.15 

Article  2.  Plans,  Construction  and 

Inspection  623 

Article  3.  Maintenance  and  Operation  623 

Chapter  21 .  Minimum  Standards  for  Permitting 

Medical  Waste  Facilities  625 

Article  1.  Definitions  and  Scope 625 

Article  2.  General  Provisions 626 

Article  3.  Medical  Waste  Treatment 

Facility  Permits 626.1 

Article  4.  Fees  626.4 

Chapter  22.  Safety  Regulations  for 

Playgrounds  626.4 

Article  1 .  Definitions 626.4 

Article  2.  General  Standards   626.5 

Article  3.  Certified  Playground  Safety 

Inspector  Requirements  626.6 

Article  4.           Provisions  for  Child  Care 
Centers  and  Facilities 
Operated  for  the 
Developmentally  Disabled  626.6 


CODE  OF  REGULATIONS  Title  22 

Page 

Division  4.5.        Environmental  Health  Standards 
for  the  Management  of 
Hazardous  Waste 627 

Chapter  10.  Hazardous  Waste  Management 

System:  General  627 

Article  1.  General 627 

Article  1.5.        Conflict  of  Interest  Code 635 

Article  2.  Definitions 637 

Article  3.  Variances  657 

Chapter  11.  Identification  and  Listing  of 

Hazardous  Waste  660 

Article  1.  General 660 

Article  2.           Criteria  for  Identifying  the 
Characteristics  of 
Hazardous  Waste 668.3 

Article  3.  Characteristics  of  Hazardous 

Waste 668.3 

Article  4.  Lists  of  Rcra  Hazardous 

Wastes 668.6 

Article  4. 1 .        Additional  Lists  of 

Hazardous  Wastes 681 

Articles.  Categories  of  Hazardous 

Waste 681 

Chapter  12.  Standards  Applicable  to 

Generators  of  Hazardous  Waste 692 

Article  1.  Applicability 692 

Article  2.  The  Manifest   693 

Article  3.  Pre-Transport  Requirements  694 

Article  4.  Recordkeeping  and  Reporting 698 

Article  5.  Exports  of  Hazardous  Waste 699 

Article  6.  Imports  of  Hazardous  Waste 702 

Article  7.  Farmers 703 

Article  8.           Transfrontier  Shipments  of 
Hazardous  Waste  for 
Recovery  Within  the  OECD 703 

Chapter  13.  Standards  Applicable  to 

Transporters  of  Hazardous 

Waste 714 

Article  1.  General 714 

Article  2.  Compliance  with  the  Manifest 

System  and  Recordkeeping 715 

Article  3.  Hazardous  Waste  Discharges 718 

Article  4.           Regulatory  Exemptions  for 
Certain  Transportation 
Operations 718 

Article  5.           Railroad  Accident  Prevention 
and  Immediate  Deployment 
(RAPID)  Force  720.1 


Page  X 


(7-18-20 


Title  22 


Social  Security 

Page 

Standards  for  Owners  and  Chapter  15. 

Operators  of  Hazardous  Waste 

Transfer,  Treatment,  Storage, 

and  Disposal  Facilities 720.1 

General 720.1 

Article  1 . 
General  Facility  Standards  720.3 

Article  2. 
Preparedness  and  Prevention  720.7  a  f'  1    l 

Contingency  Plan  and 

Emergency  Procedures 720.7  Article  4 

Manifest  System, 

Recordkeeping,  and  Article  5. 

Reporting 720.9 

Water  Quality  Monitoring  and 

Response  Programs  for  Article  6. 

Permitted  Facilities  720.14 

Closure  and  Post-Closure 728 

Article  7. 

Financial  Requirements  734  .    .  ,    ^ 

Article  8. 

Use  and  Management  of  Article  9 

Containers 750.18 

Tank  Systems 752  Article  10. 

Surface  Impoundments 755  Article  11. 

Waste  Piles  758.3  Article  12. 

Land  Treatment 758.6  Article  13. 

T      jf„  Article  14. 

Landfills 758.10 

Article  15. 

Residuals  Repositories  758.12(c)  .  , 

Article  16. 

Incinerators 758.12(d)  Article  17. 

Corrective  Action  for  Waste 

Management  Units 758.14  Article  1 7.5. 

Drip  Pads 758.16(d)  Article  18. 

Miscellaneous  Units   758.18 

Environmental  Monitoring  and  Article  27 

Response  Programs  for  Air, 

Soil,  and  Soil-Pore  Gas  for 

Permitted  Facilities  758.18(a)  Article  28. 

Corrective  Action  for  Solid  *  _•  i    -,o  ^ 

TT  •  Article  28.5. 

Waste  Management  Units  758.18(d) 

Air  Emission  Standards  for 

Process  Vents  758.45 

Air  Emission  Standards  for  Article  29. 

Equipment  Leaks  758.52  ^^^^^^^  ^^ 

Air  Emission  Standards  for 

Tanks,  Surface  Article  I. 

Impoundments,  and  \    ■  \   i 

Containers 758.54(d) 

Containment  Buildings 758.54(s) 


Title  Table  of  Contents 

Page 

Interim  Status  Standards  for 

Owners  and  Operators  of 

Hazardous  Waste  Transfer, 

Treatment,  Storage,  and 

Disposal  Facilities  758.54(u) 

General 758.54(u) 

General  Facility  Standards  758.54(w) 

Preparedness  and 

Prevention 758.54(z)(i) 

Contingency  Plan  and 

Emergency  Procedures 758.54(z)(l) 

Manifest  System, 

Recordkeeping,  and 

Reporting 758.54(z)(3) 

Water  Quality  Monitoring  and 

Response  Programs  for 

Interim  Status  Facilities 758.54(z)(8) 

Closure  and  Post-Closure 758.62 

Financial  Requirements  758.69 

Use  and  Management  of 

Containers 758.81 

Tank  Systems 758.81 

Surface  Impoundments 758.90 

Waste  Piles  758.93 

Land  Treatment 758.95 

Landfills 758.98 

Incinerators 758.103 

Thermal  Treatment 758.104 

Chemical,  Physical,  and 

Biological  Treatment 758.105 

Drip  Pads 758.106 

Environmental  Monitoring  of 

Air  and  Soil-Pore  Gas  for 

Interim  Status  Facilities 758.108 

Air  Emission  Standards  for 

Process  Vents  758.112(a) 

Air  Emissions  Standards  for 
Equipment  Leaks  758.112(g) 

Air  Emission  Standards  for 

Tanks,  Surface 

Impoundments,  and 

Containers 758.112(0(1) 

Containment  Buildings  ....  758.1  I2(i)(23) 

Recyclable  Materials  (Recyclable 
Hazardous  Wastes) 758.il2(n) 

General 758.ll2(n) 

Generator,  Transporter  and 

Facility  Operator 

Requirements 758.ii2(n) 


Chapter  14. 

Article  1. 
Article  2. 
Article  3. 
Article  4. 

Article  5. 
Article  6. 


Article  7. 

Article  8. 

Article  9. 

Article  10. 

Article  11. 

Article  12. 

Article  13. 

Article  14. 

Article  14.5 

Article  15. 

Article  15.5 

Article  15.7 

Article  16. 

Article  17. 

Article  19. 
Article  27. 
Article  28. 
Article  28.5. 

Article  29. 


Page  xi 


(7-18-2008) 


Title  Table  of  Contents BARCLAYS  CALIFORNIA 

Page 

Article  3.  Requirements  for  Recyclable 

Materials  That  Are  Placed 
on  the  Land  (Used  in  a 
Manner  That  Constitutes 

Disposal)    758.112(0) 

Article  4.           Hazardous  Wastes  and  Certain 
Used  Oils  Regulated  as 
Hazardous  Waste  Fuels 758.1  I2(p) 

Article  5.  [Reserved] 758.1  I2(q) 

Article  6.  Requirements  for  Management 

of  Used  Oil   758.1 12(q) 

Article  7.           Requirements  for  Management 
of  Spent  Lead-Acid  Storage 
Batteries 758.1  I2(r) 

Article  8.           Hazardous  Waste  Burned  in 
Boilers  and  Industrial 
Furnaces 758.1  I2(s) 

Article  8.5.        Requirements  for 

Management  of  Recyclable 

Materials  Used  in 

Agriculture  758.ll2(z)(i4) 

Article  9.  Requirements  for 

Management  of  Waste 

Elemental  Mercury 758.1  I2(z)(i5) 

Article  10.         Requirements  for 

Management  of  Certain 

Oily  Wastes 758.1  I2(z)(i5) 

Chapter  17.  Military  Munitions 758.i22(z)(2) 

Chapter  18.  Land  Disposal 

Restrictions 758.l22(z)(2) 

Article  1.  General 758.l22(z)(2) 

Article  2.           Schedule  for  Land  Disposal 
Prohibition  and 
Establishment  of  Treatment 
Standards 758.123 

Article  3.  Prohibitions  on  Land 

Disposal  758.128 

Article  4.  Treatment  Standards  758.133 

Articles.  Prohibitions  on  Storage  758.190 

Article  10.         Land  Disposal  Prohibitions — 

Non-RCRA  Wastes 758.191 

Article  1 1 .         Treatment  Standards — Non- 
RCRA  Waste  Categories  758.191 

Article  12.         Incineration  Requirements  of 

Certain  Hazardous  Waste 758.192(b) 

Chapter  19.  Fees 758.262 

Chapter  20.  The  Hazardous  Waste  Permit 

Program 758.271 

Article  1.  General  Information  758.271 


CODE  OF  REGULATIONS  Title  22 

Page 

Article  2.  Permit  Application 758.273 

Article  3.  Permit  Conditions 758.287 

Article  4.  Permit  Changes  and  Denials 758.289 

Article  5.  Expiration  and  Continuation 

of  Permits   758.294 

Article  6.  Special  Forms  of  Permits 758.294 

Article  6.5.        Standardized  Permits 758.30()(b) 

Article  7.  Interim  Status 758.300(d) 

Chapter  2 1 .  Procedures  for  Hazardous  Waste 

Permit  Decisions 758.304(b) 

Article  1.  General  Program 

Requirements 758, 304(b) 

Article  2.           Specific  Procedures 
Applicable  to  RCRA 
Permits  758.304(h) 

Chapter  22.  Enforcement,  Inspections,  and 

Informant  Rewards  758.304(i) 

Article  1.  Inspection  Authority, 

Designation  of  Enforcement 
Authority,  and  Awards  758.304(i) 

Article  2.  Delegation  of  Enforcement 

Order  Authority 758.305 

Article  3.  Assessment  of  Administrative 

Penalties 758.306 

Chapter  23.  Standards  for  Universal  Waste 

Management 758.306(d) 

Article  1 .  General 758.306(d) 

Article  2.           Standards  for  Small  Quantity 
Handlers  of  Universal 
Waste 758.306(1)(]) 

Article  3.           Standards  for  Large  Quantity 
Handlers  of  Universal 
Waste 758.306(0(1 1) 

Article  4.  Standards  for  Universal 

Waste  Transporters 758.306(l)(22) 

Article  5.  Standards  for  Destination 

Facilities 758.306(l)(25) 

Article  6.  Import  Requirements 758.306(1)(26) 

Article  7.  Standards  for  CRT  Material 

Handlers 758.306(1)(26) 

Chapter  29.  Standards  for  the  Management 

of  Used  Oil  758.306(1)(32) 

Article  1.  Definitions 758.306(1)(32) 

Article  2.  Applicabihty 758.306(0(33) 

Article  3.  Standards  for  Used  Oil 

Generators 758.306(m) 

Article  4.  Standards  for  Used  Oil 

Collection  Centers  758.306(n) 


Page  xii 


(7-18-2008) 


Title  22 


Social  Security 

Page 

Standards  for  Used  Oil  Article  5. 

Transporters  and  Transfer 

Facilities  (66279.40) 

[Reserved] 738.306(n) 

Standards  for  Used  Oil 

Recycling  Facilities 

(66279.50)  [Reserved]  758.306(n) 

[Reserved] 758.306(n)  Chapter  45.5. 

[Reserved] 738.306(n) 

[Reserved] 758.306(n)  Article  1. 

Testing  Standards  and 

Recordkeeping 

Requirements 758.306(n) 

Chapter  46. 
Waste  Minimization  758.315 

Hazardous  Waste  Source 

Reduction  and  Management 

Review  758.315  Chapter  47. 

Article  1. 
Management  of  Tanks  758.325 

Best  Management  Practices  for 
Perchlorate  Materials  758.329 

General 758.329  Article  2. 

Alternative  Management 

Standards  for  Treated  Wood  Chapter  50. 

Waste 758.330(c)  Article  1. 

Hazardous  Waste  Property  and 

Border  Zone  Property 758.330(g)  Article  1.5. 

Selection  and  Ranking  Criteria  Art'  l    9 

for  Hazardous  Waste  Sites 

Requiring  Remedial  Action  758.330(h) 

„    ,  .,  .     ,  ^,  ,  r^  .,  Chapter  51. 

Prohibited  Chemical  Toilet 

Additives 758.333  Article  1 . 

Requirements  for  Management  of 

Fluorescent  Light  Ballasts  Chapter  51.5. 

which  Contain  Polychlorinated  Article  1 . 

Biphenyls  (PCBs) 758.335 

Additional  Requirements  for 

Management  of  Extremely 

Hazardous  Wastes  758.336  Chapter  52. 

Hazardous  Waste  Testing 

Laboratory  Certification  758.336      Division  5 

Requirements  for  Units  and 
Facilities  Deemed  to  Have  a 
Permit  by  Rule 758.336 

Permit  By  Rule  758.336  Chapter  1. 

[Reserved] 758.338(1)  Article  1 . 

[Reserved] 758.338(1)  Article  2. 

[Reserved] 758.338(1)  Article  3. 


Title  Table  of  Contents 

Page 

Requirements  Applicable  to 

the  Operation  of  K-12 

Schools  Hazardous  Waste 

Collection,  Consolidation, 

and  Accumulation  Facilities 

(SHWCCAF)  Deemed  to  Have 

a  Permit  by  Rule 758.338(1) 

Procurement  of  Site  or  Facility 

Cleanup  Services  758.342 

Selection  Process  for 

Private  Architectural  and 

Engineering  Services  for 

Sites  or  Facilities 758.342 

Hazardous  Waste  Environmental 

Technology  Certification 

Program  758.345 

Loan  Programs  758.346(a) 

Cleanup  Loans  and 

Environmental  Assistance  to 

Neighborhoods  Revolving 

Loan  Fund 758.346(a) 

Groundwater  Remediation 

Loan  Program   758.346(h)(2) 

Corrective  Action 758.346(j) 

Department  of  Toxic 

Substances  Control 758.346(j) 

Unified  Program  Agency 
Qualification 758.347 

Corrective  Action 

Approach 758.348(e) 

Site  Remediation  758.348(e) 

Private  Site  Management 
Performance  Standards 758.348(e) 

Assessment  of  School  Sites  758.355 

Phase  I  Environmental  Site 

Assessments  (Proposed  New 

and  Expanding  School 

Sites)  758.355 

Voluntary  Registration  of 
Environmental  Assessors  758.358(a) 

Licensing  and  Certification  of 
Health  Facilities,  Home  Health 
Agencies,  Clinics,  and  Referral 
Agencies  759 

General  Acute  Care  Hospitals 759 

Definitions 759 

License 763 

Basic  Services  767 


• 


Article  5. 

Article  6. 

Article  7. 
Article  8. 
Article  9. 
Article  10. 


Chapter  31. 
Article  1 . 


Chapter  32. 
Chapter  33. 

Article  1. 
Chapter  34. 

Chapter  39. 
Chapter  40. 

Chapter  41. 
Chapter  42. 

Chapter  43. 

Chapter  44. 
Chapter  45. 

Article  1. 
Article  2. 
Article  3. 
Article  4. 


Page  xiii 


(7-18-2008) 


Title  Table  of  Contents BARCLAYS  CALIFORNIA 

Page 

Article  4.  Supplemental  Service 

Approval  774 

Article  5.  Special  Permit  775 

Article  6.  Supplemental  Services  776 

Article  7.  Administration 798 

Article  8.  Physical  Plant 808 

Article  9.  Regulations  Specific  to 

Small  and  Rural  Hospitals 814 

Chapter  2.  Acute  Psychiatric  Hospital  815 

Article  1.  Definitions 815 

Article  2.  License 817 

Article  3.  Basic  Services  821 

Article  4.  Supplemental  Service 

Approval  826 

Article  5.  Supplemental  Services  827 

Article  6.  Administration 827 

Article  7.  Physical  Plant 833 

Chapter  2.5.  Certified  Nurse  Assistant 

Program  837 

Article  1 .  Definitions 837 

Article  2.  Administration 840 

Article  3.  Program  Components 841 

Article  4.            Continuing  Education  and  In- 
Service  Training  845 

Article  5.  Adverse  Actions  and 

Corrective  Remedies 847 

Chapter  3.  Skilled  Nursing  Facilities  848 

Article  1 .  Definitions 848 

Article  2.  License  848.4 

Article  3.  Required  Services 848.5 

Article  4.  Optional  Services  853 

Article  5.  Administration 859 

Article  6.  Physical  Plant 867 

Article  7.  Violations  and  Civil 

Penalties 871 

Chapter  3.5.          Receivership  Management  of  Long- 
Term  Care  Facilities  873 

Chapter  4.  Intermediate  Care  Facilities 873 

Article  ] .  Definitions 873 

Article  2.  License  876.1 

Article  3.  Services  881 

Article  4.  Administration 901 

Article  5.  Physical  Plant 906 


CODE  OF  REGULATIONS  Title  22 

Page 

Article  6.  Violations  and  Civil 

Penalties 91 1 

Chapter  4.5.  Intermediate  Care  Facility/ 
Developmentally  Disabled- 
Nursing  914 

Chapter  5.  Referral  Services  914 

Article  1.  Definitions 914 

Article  2.  License 915 

Article  3.  Administration 950 

Article  4.  Services  950 

Article  5.  Personnel  Requirements 951 

Article  6.  General  Provisions 952 

Chapter  6.  Home  Health  Agencies  952 

Article  L  Definitions 952 

Article  2.  License  956 

Article  3.  Services  959 

Article  4.  Administration 962.2 

Article  5.  Qualifications  for  Home 

Health  Aide  Certification 962.9 

Chapter  7.  Primary  Care  Clinics 962.10 

Article  1.  Definitions 962.10 

Article  2.  License 963 

Article  3.  Basic  Services  964 

Article  4.  Drug  Distribution 965 

Article  5.  Abortion  Service 966 

Article  6.  Administration 966 

Article  7.  Physical  Plant 968 

Article  8.  Appeals  Procedure 969 

Article  9.  Birth  Services 970 

Chapter  7.L         Specialty  Clinics 971 

Article  6.  Hemodialyzer  Reuse  971 

Chapter  7.2.         Psychology  Clinics  977 

Article  L  Definitions 977 

Article  2.  License 977 

Article  3.  Basic  Services  977 

Article  4.  Administration 978 

Article  5.  Physical  Plant 980 

Chapter  8.  Intermediate  Care  Facilities  for 

the  Developmentally  Disabled  981 

Article  1.  Definitions 981 

Article  2.  License 985 

Article  3.  Services  990 

Article  4.  Administration 1006 

Article  5.  Physical  Plant 1016 


Page  xiv 


(7-18-2008) 


Title  22 


Social  Security 

Page 

Violations  and  Civil  Division  6. 

Penalties 1020 

Intermediate  Care  Facilities/  Chapter  1 . 

Developmentally  Disabled —  Article  1 . 

Habilitative 1023  Article  2 

Definitions 1023  Article  3. 

License  1025  Article  4. 

Services  1026  Article  6. 

Administration 1036  Article  7. 

nu    •    1  ni     *  ,^.^  Article  8. 

Physical  Plant 1042 

Violations  and  Civil 

Penalties 1044  Chapter  2. 

Psychiatric  Health  Facilities 1044  Subchapter  1 

Definitions 1044  Article  1 . 

Licensing  and  Inspection 1047 

Article  2. 
Services  1049 

Article  3. 
Administration 1054 

Article  4. 

Physical  Plant 1058.2  .    .  .    ^ 

Adult  Day  Health  Centers 1058.2 

Article  6. 
Definitions 1058.2 

Article  7. 
License  1061 

Chapter  3. 
Services  1063 

Article  1. 
Administration 1068 

Article  2. 

Physical  Plant 1072  .    •  .    ^ 

Violations 1073  Article  4 

Chemical  Dependency  Recovery 

Hospital  Licensing  Regulations  .....  1074  Articles. 

T-»  *•   •^-  .^-,.  Article  6. 

Definitions 1074 

Article  7. 
Licensing  and  Inspection 1075 

Article  8. 
Basic  Services  1077 

^    .       ,  r.      •  Chapter  3.5. 

Optional  Services  1080 

Article  1. 

Administration 1080 

Article  2. 

Physical  Plant 1085  .    .  .    ^ 

Correctional  Treatment  Centers  1085  Article  4. 

Definitions 1085 

Article  5. 
Licensing  and  Inspection 1086.3 

Article  6. 

Required  Services 1086.4  .    .  ,    _ 

Optional  Services  1086.13 

Chapter  4. 

Administration 1086.20  *  .-  i    i 

Article  1 . 

Physical  Plant  and  Safety   1086.27 


Title  Table  of  Contents 

Page 

Licensing  of  Community  Care 
Facilities i087 

General  Licensing  Requirements  ....  1087 

General  Definitions  1087 

License 1091 

Application  Procedures  1092 

Administrative  Actions 1103 

Continuing  Requirements  1 107 

Physical  Environment 1119 

Incidental  Medical 

Services  1120 

Social  Rehabilitation 

Facilities  1120.4 

Basic  Requirements 1 120.4 

General  Requirements  and 

Definitions 1120.4 

Licensing 1 120.5 

Applications  Procedures  1 120.5 

Administrative  Actions 1 120.6 

Enforcement  Provisions 

(Reserved) 1120.6 

Continuing  Requirements  1 120.6 

Physical  Environment 1120.11 

Adult  Day  Programs 1120.12 

General  Requirements 1120.12 

Licensing 1 120.16 

Application  Procedures  1120.17 

Administrative  Actions  and 

Inspection  Authority  1 120.25 

Enforcement  Provisions 1120.26 

Continuing  Requirements  1120.28 

Physical  Environment 1120.38 

Incidental  Medical  Services 1120.40 

Adult  Day  Support  Center  1120.44 

General  Requirements 1120.44 

Licensing  (Reserved)  1120.44 

Application  Procedures  1120.44 

Administrative  Actions 

(Reserved) 1 120.44 

Civil  Penalties  (Reserved) 1120.44 

Continuing  Requirements  1120.44 

Physical  Environment 1120.46 

Small  Family  Homes  1120.46 

General  Requirements  and 

Definitions 1 120.46 


Article  6. 
Chapter  8.5. 

Article  1. 
Article  2. 
Article  3. 
Article  4. 
Article  5. 
Article  6. 

Chapter  9. 
Article  1. 
Article  2. 
Article  3. 
Article  4. 
Article  5. 

Chapter  10. 
Article  1. 
Article  2. 
Article  3. 
Article  4. 
Article  5. 
Article  6. 

Chapter  11. 

Article  1. 
Article  2. 
Article  3. 
Article  4. 
Article  5. 
Article  6. 

Chapter  12. 
Article  1. 
Article  2. 
Article  3. 
Article  4. 
Article  5. 
Article  6. 


Page  XV 


(7-18-2008) 


Title  Table  of  Contents BARCLAYS  CALIFORNIA 

Page 

Article  2.  Licensing 1120.47 

Article  3.  Application  Procedures  1 121 

Article  4.  Administrative  Actions 

(Reserved) 1121 

Article  5.  Enforcement  Provisions 1121 

Article  6.  Continuing  Requirements  1121 

Article  7.  Physical  Environment 1 1 26.  i 

Chapter  5.  Group  Homes 1 126.2 

Article  L  General  Requirements  and 

Definitions 1126.2 

Article  2.  Licensing 1129 

Article  3.  Application  Procedures  1129 

Article  4.  Administrative  Actions 1131 

Article  5.  Enforcement  Provisions 1131 

Article  6.  Continuing  Requirements  1132 

Article  7.  Physical  Environment 1134.13 

Article  9.  Administrator  Certification 

Training  Programs  1134.14 

Subchapter  1 .       Community  Treatment 

Facilities 1134.14(c) 

Article  L  General  Requirements  and 

Definitions 1134.14(c) 

Article  2.  Licensing  (Reserved)  1134.14(d) 

Article  3.  Application  Procedures  1134.14(d) 

Article  4.  Administrative  Actions 1134.14(d) 

Article  5.  Enforcement  Provisions 1134.14(e) 

Article  6.  Continuing  Requirements  1134.14(e) 

Article  7.  Physical  Environment 1134.14(1) 

Subchapter  2.       Care  for  Children  Under 

the  Age  of  Six  Years  Il34.i4(j) 

Article  L  General  Requirements  and 

Definitions Ii34.i4(j) 

Article  3.  Application  Procedures  Ii34.i4(k) 

Article  6.  Continuing  Requirements  —  Il34.i4(k) 

Article  7.  Physical  Environment Il34.i4(r) 

Subchapter  3.       Emergency  Intervention  in 

Group  Homes 1134.i4(s) 

Article  L  General  Requirements Il34.i4(s) 

Article  3.  Application  Procedures  Il34.i4(t) 

Article  6.  Continuing  Requirements  1134.17 

Subchapter  4.       Transitional  Shelter  Care 

Facilities 1134.18 

Article  L  General  Requirements 1134.18 

Article  2.  License 1134.19 

Article  3.  Application  Procedures  1134.19 


CODE  OF  REGULATIONS  Title  22 

Page 

Chapter  6.  Adult  Residential  Facilities   1 134.20 

Article  L  General  Requirements  and 

Definitions 1 1 34.20 

Article  2.  Licensing 11 34.22 

Article  3.  Application  Procedures  1134.22 

Article  4.  Administrative  Actions 

(Reserved) 1 134.22 

Article  5.  Enforcement  Provisions 1134.22 

Article  6.  Continuing  Requirements  1134.22 

Article  7.  Physical  Environment 1 140.2(b) 

Article  9.  Administrator  Certification 

Training  Programs  1140.4 

Chapter  7.  Transitional  Housing  Placement 

Program 1140.7 

Article  L  General  Requirements 1140.7 

Article  2.  License  Required  1 140.8 

Article  3.  Application  Procedures  1140.8 

Article  4.  Administrative  Actions 1 140.1 1 

Article  5.  Enforcement  Provisions 

(Reserved) 1140.12 

Article  6.  Continuing  Requirements  1140.12 

Article  7.  Physical  Environment 1 140.18(a) 

Chapter  7.3.  Crisis  Nurseries 1140.19 

Article  L  General  Requirements  and 

Definitions 1 140.19 

Article  2.  License  Required  1140.22 

Article  3.  Application  Procedures  1140.25 

Article  4.  Administrative  Actions 1140.36 

Article  5.  Enforcement  Provisions 1140.37 

Article  6.  Continuing  Requirements  1140.40 

Article  7.  Physical  Environment 1140.56 

Chapter  7.5.  Foster  Family  Homes 1140.59 

Article  L  General  Requirements  and 

Definitions 1140.59 

Article  2.  License 1140.59 

Article  3.  Application  Procedures  1141 

Article  4.  Administrative  Actions 1144 

Article  6.  Continuing  Requirements  1146 

Article  7.  Physical  Environment 1149 

Chapter  8.  Residential  Care  Facilities  for 

the  Elderly  (RCFE)  1149 

Article  1.  Definitions  and  Forms  1149 

Article  2.  License 1154 

Article  3.  Application  Procedures  1158 

Article  4.  Operating  Requirements  1160 


Page  xvi 


(7-18-20 


Title  22 


Social  Security 

Page 

Physicial  Environment  and  Article  1. 

Accommodations  1 167 

Background  Check 1170  Article  2. 

Personnel 1174  Article  3. 

Resident  Assessments,  Article  4. 

Fundamental  Services  and  Article  5. 

Rights  1178 

Chapter  10. 
Resident  Records  1 1 80.2(b) 

Food  Services 11 80.2(c) 

Health-Related  Services  and  -..  .  . 

_     ,. .  Division  7. 

Conditions ll80.2(i) 

Dementia l I80.2(s) 

Chapter  1. 
Enforcement l]80.2(y) 

Administrative  Actions —  Article!. 

General ii80.2(z)(2)  .    ■.    ^ 

Article  2. 

Administrator  Certification  *  ^-  i    -» 

rr.    •  •      r,  ,7     ,  Article  3. 

Training  Programs  —  Vendor 

Information 1180.2(z)(2) 

Article  4. 

Residential  Care  Facilities  for  Article  5 

the  Chronically  111  I180.2(z)(6) 

Article  6. 

License 1180.2(z)(6) 

Definitions ll80.2(z)(6) 

Application  Procedures  1180.4  Article  7. 

Administrative  Actions 1180.15  Articles. 

Enforcement  Provisions 1180.16  Article  9. 

Continuing  Requirements  1180.19 

„,      .    1  r^  Article  1 1 . 

Physical  Environment 1180.25 

Article  12. 
Medical  and  Health  Related 

Care 1180.27 

Foster  Family  Agencies 1180.37  Chanter  2 

General  Requirements  and 

Definitions 1180.37  Article  1. 

License 1180.38  Article  2. 

Apphcation  Procedures  1180.38 

Certification  and  Use  of  Chapter  3. 

Homes 1182 

Administrative  Actions 1182.1  Article!. 

Complaints  1182.2  Article  2. 

Continuing  Requirements  1182.2  Article  3. 

Physical  Environment 11 82.8(a)  Article  4. 

Article  5. 
Adoption  Agencies  1182.9 

License 1182.9  Article  6. 

Administration 1182.10  ^.      ,      . 

Chapter  4. 

Foster  Family  Homes  1 1 82. 14  Article  ! . 


Title  Table  of  Contents 

Page 

General  Requirements, 

Definitions,  and  Forms 1182.14 

Administrative 1185 

License/Approval  Standards 1 186.8 

Placement  1186.14 

Special  Health  Care  Needs  1186.16 

Regulations  Regarding 

Supervision  of  Life  Care 

Contracts  1186.19 

Health  Planning  and  Facility 
Construction 1191 

Health  Planning  and  Resources 
Development  1191 

Definitions 1191 

Advisory  Health  Council 1 193 

Area  Health  Planning 

Agencies 1195 

Office  Functions  1195 

Certificate  of  Need 1 196 

Hearing  Procedure  on 

Applications  for  a 

Certificate  of  Need 1 198 

Appeals 1199 

Certificate  of  Exemption  1200 

Terms  and  Conditions 1200 

Development  of  Plans 1201 

Review  Criteria 1202 

Procedures  and  Requirements 
Relating  to  the  California 
Environmental  Quality  Act 1204 

Eminent  Domain  Procedures  for 
Nonprofit  Hospitals 1205 

Definitions 1205 

General  Provisions  and 

Procedures 1206 

Freestanding  Cardiac 

Catheterization  Pilot  Project  1208 

General  Provisions 1208 

Monitoring  1209 

Fees  1210 

Operational  Requirement 1210 

Compliance  with  Other  Laws 

and  Regulations 1210 

Definitions 1211 

Fire  Protection  Loans 1211 

Definitions 1211 


Article  5. 


Article  6. 

Article  7. 

Article  8. 

Article  9. 

Article  10, 

Article  11. 

Article  12. 

Article  13. 

Article  14. 

Article  15. 

Chapter  8.5. 

Article  1. 
Article  2. 
Article  3. 
Article  4. 
Article  5. 
Article  6. 
Article  7. 
Article  8. 

Chapter  8.8. 
Article  1. 

Article  2. 
Article  3. 
Article  4. 

Article  5. 
Article  6. 
Article  7. 
Article  8. 

Chapter  9. 
Article  1. 
Article  2. 

Chapter  9.5. 


Page  xvii 


(7-18-2008) 


Title  Table  of  Contents BARCLAYS  CALIFORNIA 

Page 

Article  2.  General  Provisions 121 1 

Chapter  5.  Health  Facility  Construction 

Loan  Insurance  1214 

Article  L  Definitions 1214 

Article  2.  General  Provisions 1216 

Article  3.           California  Health  Facilities 
Construction  Loan  Insurance 
Program — State  Plan 1220 

Article  4.  Defaults  1220 

Article  5.  Termination  of  Insurance 1220 

Article  6.  Health  Facility  Construction 

Loan  Insurance  Fund 1220 

Article  7.           California  Health  Facilities 
Construction  Loan  Insurance 
Program — Stale  Plan 1220 

Chapter  6.  Health  Workforce  Pilot  Project 

Program  1220 

Article  1.  Definitions 1220 

Article  2.  Minimum  Standards  1221 

Article  3.  Application  Procedure  1221 

Article  4.  Content  of  Application 1222 

Article  5.  Application  Review  Process 1224 

Article  6.  Project  Approval 1224 

Article  7.  Program  Responsibilities 1224 

Article  8.  Project  Completion/ 

Termination 1225 

Chapter  7.  Seismic  Structural  Safety 

Standards 1226 

Article  1.  General  Provisions 1226 

Article  2.  Definitions 1226 

Article  3.  Approval  of  Drawings  and 

Specifications 1226.1 

Article  4.  Fees  1226.2 

Article  5.  Approval  of  Construction  1226.2 

Article  6.  Appeals  Procedures  of  the 

Building  Safety  Board  1227 

Article  7.  General  Design  Requirements 

(Testing  and  Inspection) 1227 

Article  8.  Masonry  (Testing  and 

Inspection) 1227 

Article  9.  Wood  (Testing  and 

Inspection) 1227 

Article  10.         Concrete  (Testing  and 

Inspection) 1227 

Article  11.  Steel  and  Iron  (Testing  and 

Inspection) 1228 


CODE  OF  REGULATIONS  Title  22 

Page 

Article  12.         Aluminum  (Testing  and 

Inspection) 1228 

Article  13.         Excavations,  Foundations  and 
Retaining  Walls  (Testing 
and  Inspections)  1228 

Article  14.         Veneer  (Testing  and 

Inspection) 1228 

Article  15.         Masonry  or  Concrete 

Chimneys,  Fireplaces  and 

Barbecues  (Testing  and 

Inspection) 1228 

Article  16.         Contracts  1228 

Chapter  8.  Clinic  Renovation  (Construction) 

Grant  and  Loan  Program 1228 

Article  1.  Definitions 1228 

Article  2.  Eligibility 1229 

Article  3.  Types  of  Assistance 1229 

Article  4.  General  Provisions 1229 

Article  5.  Application  for  Funds 1229 

Article  6.  Selection  Process  1229 

Article  7.  Administration 1230 

Chapter  9.  Hospital  Charges  and  Fair 

Pricing  Policies  Reporting  1230 

Article  1.  Hospital  Charge  Description 

Master  Reporting  1230 

Article  2.  Hospital  Fair  Pricing 

Policies  Reporting  1231 

Chapter  10.  Health  Facility  Data  1232 

Article  1.  General 1232 

Article  2.  Accounting  System 

Requirements 1233 

Article  3.  Reporting  Requirements  1235 

Article  4.  Modification,  Extension,  and 

Appeal  Processes  1236 

Article  5.  Collection  of  Special  Fees 1236.2 

Article  6.  Public  Availability  of 

Disclosure  Materials  1237 

Article  7.  CABG  Data  Reporting 

Requirements 1237 

Article  8.  Patient  Data  Reporting 

Requirements 1238.7 

Chapter  11.  Alzheimer's  Disease  Institute 

Demonstration  Project  1251 

Subchapter  1.  Definitions 1251 

Subchapter  2.  General  Requirements 1263 

Article  1.  Institute  Administration 1263 

Article  2.  Patient  Services  Management  1267 


Page  xviii 


(7-18-2008) 


Title  22 


Social  Security 
Page 

Staff 1283  Subchapter  9. 

Environmental  Safety  and 

Health  1288  Article  1 . 

Physical  Plant 1289  Article  2. 

Standards  for  All  Types  of  Article  3. 

Services  1295  Article  4. 

Monitoring  and  Compliance 1295  Article  5. 

Skilled  Nursing  Services  1297  Subchapter  10. 

Definitions 1297  Article  1. 

Designation 1297  Article  2. 

Required  Services 1297  Article  3. 

Administration 1301  Article  4. 

Intermediate  Care  Article  5. 

Services  1301  Subchapter  1 1 . 

Definitions 1301  Article  1. 

Designation 1301  Article  2. 

Services  1302  Article  3. 

Administration 1303  Article  4. 

Outpatient  Care  Article  5. 

Definitions 1303  Article  6. 

Definitions 1303  Article  7. 

Designation 1304  Subchapter  12. 

Basic  Services  1304 

^       ^.     .,     .  Article  1. 

Drug  Distribution 1305 

....        .  Article  2. 

Administration 1306 

Article  3. 
Day  Health  Care  Services  1306 

Definitions 1306  Article  4 

Designation 1307  Subchapter  13. 

Services  1307  Article  1. 

Administration 1309  Article  2. 

Physical  Plant 131 1  Article  3. 

Social  Day  Care  Services   I3il  Article  4. 

Definitions 1311  Chapter  12. 

Administration 131 1 

Patient  Services 1312  Article  1 . 

Designation 1313  Article  2. 

Home  Health  Care  ^^^^^'^  ^■ 

Services  1313  Article  4. 

Definitions 1313  Article  5. 

Designation 1313  Article  6. 

Services  1314  Article  7. 

Administration 1316  Article  8. 

Qualifications  for  Home  Chapter  13. 

Health  Aide  Certification 1317 


Title  Table  of  Contents 

Page 

In-Home  Supportive 

Services  1318 

Definition 1318 

Designation 1318 

Services  1318 

Staff 1319 

Administration 1319 

Respite  Care  Services 1319 

Definitions 1319 

Training  1320 

Administration 1320 

Services  1320 

Designation 1320 

Hospice  Care  Services  1321 

Definitions 1321 

Required  Services 1321 

Staff 1322 

Continuity  of  Care  1323 

Other  Services  1324 

Administration 1325 

Designation 1325 

Residential  Care 

Services  1325 

Definitions 1325 

Designafion 1325 

Administration  and  Staffing 
Requirements 1325 

Basic  Services  1326 

Referral  Services 1329 

DefiniUons 1329 

Designation 1329 

Administration 1329 

Services  1330 

Postsurgical  Recovery  Care 
Demonstration  Project  1330 

Definitions 1330 

Required  Services 1335 

General  Requirements 1339 

Administration 1341 

Fees  1345 

Operational  Requirements 1 345 

Monitoring  and  Compliance 1345 

Physical  Plant 1346.1 

Mobile  Cardiac  Catheterization 

Pilot  Project  1347 


• 


Article  3. 
Article  4. 

Article  5. 
Article  6. 

Arncle  7. 
Subchapter  3. 

Article  1. 

Article  2. 

Article  3. 

Article  4. 
Subchapter  4. 

Article  1. 
Article  2. 
Article  3. 
Article  4. 
Subchapter  5. 

Article  1. 

Article  2, 

Article  3. 

Article  4. 

Article  5. 
Subchapter  6. 

Article  1. 

Article  2. 

Article  3. 

Article  4. 

Article  5. 
Subchapter  7. 

Article  1. 

Article  2. 

Article  3. 

Article  4. 
Subchapter  8. 

Article  1. 
Article  2. 
Article  3. 
Article  4. 
Article  5. 


Page  xix 


(7-18-2008) 


Title  Table  of  Contents BARCLAYS  CALIFORNIA 

Page 

Article  1 .  Definitions 1347 

Article  2.           Relationship  Between  Base 
and  Host  Hospital  During 
Pilot  Program  Operation  1347 

Article  3.  General  Provisions 1347 

Article  4.  Interim  Program  Use  of 

Mobile  Lab  When  Replacing  a 
Hospital  Based  Cardiac 
Catheterization  Laboratory 1348 

Article  5.  Monitoring  and  Record 

Keeping  1348 

Article  6.  Fees  1 348 

Article  7.  Operational  Requirement 1348 

Article  8.  Compliance  with  Other  Laws 

and  Regulations 1348 

Chapter  14.  Minority  Health  Professions 

Education  Foundation 1349 

Article  1 .  Definitions 1349 

Article  2.  General  Provisions 1352.3 

Article  3.  Scholarships  1352.4 

Article  4.  Loan  Repayment  Program 1352.6 

Article  5.  Registered  Nurse  Education 

Program  1352.6 

Article  6.  Appeals 1352.7 

Article  7.  Citizenship  and  Alien 

Verification  Requirements 1352.8 

Chapter  15.  Associate  Degree  Nursing 

Scholarship  Program 1352.15 

Chapter  16.  Vocational  Nurse  Scholarship  and 

Loan  Repayment  Program  1352.17 

Article  1.  General  Provisions 1352.17 

Article  2.  Scholarship  Program 

Provisions  1352.18 

Article  3.  Loan  Repayment  Program 

Provisions  1352.20 

Chapter  17.  Licensed  Mental  Health  Service 

Provider  Education  Program  1352.21 

Division  8.           Nondiscrimination  in  State- 
Supported  Programs  and 
Activities  1353 

Chapter  1.  Purpose,  General  Definitions  and 

General  Provisions 1353 


CODE  OF  REGULATIONS  Title  22 

Page 

Article  1.  Purpose  and  General 

Provisions  1353 

Article  2.  General  Definitions  1354 

Article  3.  Applicability 1354 

Chapter  2.             Discriminatory  Practices 
Relating  to  All  Groups 
Protected  by  Article  9.5 1355 

Article  1.  General  Prohibitions  Against 

Discrimination 1355 

Article  2.  Mandatory  and  Permissive 

Remedial  Action 1355 

Chapter  3.  Discriminatory  Practices 

Relating  to  Specific  Groups 

Protected  by  Article  9.5 1356 

Article  1.  Purpose  of  This  Chapter 1356 

Article  2.  Color  and  Ethnic  Group 

Identification  1356 

Article  3.  Religion  1356 

Article  4.  Age 1 356 

Article  5.  Sex  1357 

Article  6.  Physical  or  Mental 

Disability 1 358 

Chapter  4.  Compliance  and  Enforcement 1359 

Article  1 .  State  Agency  Enforcement 

System  1359 

Article  2.  Compliance  Reports  and 

Compliance  Information  1 360 

Article  3.  Information  to 

Beneficiaries,  the  Public, 
Recipients  and  Employees  on 
Rights  and 
Responsibilities 1360 

Article  4.  Compliance  Reviews  and 

Complaints  1361 

Article  5.  Hearing  Process 1362 

Article  6.  Sanctions  1363 

Arficle  7.           Enforcement  System 
Evaluation  and 
Coordination 1363 

Chapter  5.  Relationship  Between  the 

Secretary,  DFEH  and  FEHC  1363 

Article  1 .           Incorporation  of  DFEH  and 
FEHC  Employment 
Discrimination  Regulations 
by  Reference 1363 

Article  2.  State  Agency,  DFEH  and  FEHC 

Roles  1363 


• 


Page  XX 


(7-18-2008) 


Title  22 


Social  Security 

Page 

Prehospital  Emergency  Medical  Article  2. 

Services  1365  Article  3. 

Emergency  Medical  Services 

Authority  and  Commission  on  Article  4. 

Emergency  Medical  Services —  Article  5. 

Conllict  of  Interest  Code 1365 

Training  Standards  for  Child 

Care  Providers 1365  Article  6. 

Definitions 1365  Chapter  3. 

Training  Requirements  for 

Child  Care  Providers 1366.2  Article  1 . 

Training  Program  Approval  1366.2  Article  2. 

Training  Program  Director  Article  3. 

and  Instructor 

Requirements 1366.2(a)  Article  4. 

Course  Hours  and  Class  Article  5. 

Requirements 1366.2(c)  Article  6. 

Class  Rosters,  Course  Chanter  4 

Completion  Documents  and 

Stickers 1366.2(d)  .    •  ,    . 

Article  1. 

Fees  1366.2(e)  *     •  i    n 

Article  2. 

First  Aid  Testing  for  School  Bus  Article  3. 

Drivers  1366.3 

Definitions 1366.3 

General 1366.3  Article  4. 

Examination  Standards 1366.3 

Article  5. 

First  Aid  Standards  for  Public  Article  6. 

Safety  Personnel 1366.3  a    •  i    -, 

■^  Article  7. 

Definitions 1366.3  Articles. 

General  Training  Provisions 1366.4  Article  9 

Training  Standards 1366.4 

Training  Approval  Options 1368  Chapter  5. 

Training  Standards  and 

Utilization  for  Use  of  the  Chapter  6. 

Automated  External 

Defibrillator  by  Non-Licensed 

or  Non-Certified  Personnel  1369  Article  1 

Definitions 1369  Article  2. 

General  Training  Provisions 1369  Article  3. 

AED  Training  Program 

Requirements 1370  Article  4. 

Operational  AED  Service 

ProviderA^endor  Article  5. 

Requirements 1370  „, 

^  Chapter  7. 

Emergency  Medical  Article  1 . 

Technician  I  1371  Article  2. 

Definitions 1371 


Title  Table  of  Contents 
Page 

General  Provisions 1372 

Program  Requirements  for  EMT- 

I  Training  Programs 1377 

EMT-I  Certification  1380 

Maintaining  EMT-I 

Certification  and 

Recertification  1380.1 

Record  Keeping  and  Fees  1380.2 

Emergency  Medical 

Technician-II 1380.2 

Definitions 1380.2 

General  Provisions 1380.3 

Program  Requirements  for  EMT- 

II  Training  Programs 1382 

Certification  1387 

Operational  Requirements 1388 

Record  Keeping  and  Fees  1389 

Emergency  Medical  Technician- 
Paramedic  1390 

Definitions 1390 

General  Provisions 1392 

Program  Requirements  for 

Paramedic  Training 

Programs  1 394 

Applications  and 

Examinations  1399 

Licensure 1400 

License  Renewal 1402 

System  Requirements 1402 

Record  Keeping  and  Fees  1402.2 

DiscipUne  and  Reinstatement 

of  License  1402.3 

Process  for  Applicant 

Verification 1402.5 

Process  for  EMT-I  and  EMT-II 

Certification  Disciplinary 

Action 1402.8 

Definitions 1402.8 

General  Provisions 1403 

Evaluation  and 

Investigation 1406 

Determination  and 

Notification  of  Action 1406 

Local  Responsibilities 1406.2 

Trauma  Care  Systems 1406.3 

Definitions 1406.3 

Local  EMS  Agency  Trauma 

System  Requirements  1408 


Division  9. 

Chapter  1. 

Chapter  1.1. 

Article  1. 
Article  2. 

Article  3. 
Article  4. 

Article  5. 
Article  6. 

Article  7. 
Chapter  1.2. 

Article  1. 
Article  2. 
Article  3. 

Chapter  1 .5. 

Article  1. 
Article  2. 
Article  3. 
Article  4. 

Chapter  1.8. 


• 


Article  1. 
Article  2. 
Article  3. 

Article  4. 


Chapter  2. 
Article  1, 


Page  xxi 


(7-18-2008) 


Title  Table  of  Contents BARCLAYS  CALIFORNIA 

Page 

Arlicle  3.  Trauma  Center  Requirements   1410 

Article  4.  Quality  Improvement  1414.2 

Article  5.  Transfer  of  Trauma  Patients 1414.2 

Chapter  8.  Prehospital  EMS  Aircraft 

Regulations 1414.3 

Article  1.  Definitions 1414.3 

Article  2.  General  Provisions 1414.4 

Article  3.  Personnel 1415 

Article  4.  System  Operation 1415 

Article  5.  Equipment  and  Supplies, 

Aircraft  Specifications  1415 

Chapter  9.  Poison  Control  Center 

Regulations 1416 

Article  1.  Definitions 1416 

Article  2.  General  Provisions 1416 

Article  3.  Designation  Process 1416.2 

Chapter  11.  EMS  Continuing  Education 1416.3 

Article  1.  Definitions 1416.3 

Article  2.  Approved  Continuing 

Education 1416.4 

Article  3.  Continuing  Education 

Records 1416.4 

Article  4.  CE  Provider  Approval 

Process  1416.5 

Article  5.  CE  Provider  Denial/ 

Disapproval  Process  1416.5 

Article  6.  CE  Providers  for  EMS 

Personnel 1416.5 

Chapter  12.  EMS  System  Quality 

Improvement  1416.7 

Article  1.  Definitions 1416.7 

Article  2.  EMS  Service  Provider  1416.7 

Article  3.  Paramedic  Base  Hospital 1416.7 

Article  4.  Local  EMS  Agency  1416.8 

Articles.  EMS  Authority  1416.8 

Division  10.        California  Medical  Assistance 

Commission  1417 

Chapter  1.  Introduction  1417 

Article  1.  Definitions 1417 

Article  2.  Commission  Meetings  1417 

Article  3.  Commission  Staff 1417 

Chapter  2.  Negotiation  and  Approval  of 

Proposed  Contracts  1417 


CODE  OF  REGULATIONS  Title  22 

Page 

Chapter  3.  Confidentiality  of  Contract 

Negotiations 1418 

Chapter  4.  Conflict  of  Interest  Code 1418 

Division  11 .         Department  of  Community 

Services  and  Development 1421 

Chapter  1.  Community  Services  Block  Grant 

Regulations 1421 

Chapter  2.  Low-Income  Home  Energy 

Assistance  Program  Regulations  1428 

Chapter  3.  Applicant  Verification 

Regulations 1428.5 

Chapter  4.  Naturalization  Services 

Regulations 1428.8 

Chapter  5.             Department  of  Community  Services 
and  Development — Conflict  of 
Interest  Code  1428.8 

Division  12.         Child  Care  Facility  Licensing 

Regulations 1429 

Chapter  1.  Child  Care  Center  General 

Licensing  Requirements  1429 

Article  1 .  General  Requirements  and 

Definitions 1429 

Article  2.  Licensing 1431 

Article  3.  Application  Procedures  1432 

Article  4.  Enforcement  Provisions 1441 

Article  5.  Administrative  Actions 1444 

Article  6.  Continuing  Requirements  1445 

Article  7.  Physical  Environment 1451 

Subchapter  1 .       (Reserved) 1454 

Article  I.  General  Requirements  and 

Definitions 1454 

Article  2.  Licensing 1454 

Article  3.  Application  Procedure  1454 

Article  4.  Administrative  Actions 1454 

Article  5.  Enforcement  Provisions 

(Reserved) 1454 

Article  6.  Continuing  Requirements  1454 

Article  7.  Physical  Environment 1456 

Subchapter  2.       Infant  Care  Center  1456 

Article  I.  General  Requirements  and 

Definitions 1456 

Article  2.  Licensing  (Reserved)  1456 

Article  3.  Application  Procedures 

(Reserved) 1456 

Article  4.  Enforcement  Provisions 

(Reserved) 1456 


Page  xxii 


(7-18-2008) 


Title  22 


Social  Security 

Page 

Administrative  Actions  Article  4. 

(Reserved) 1456 

Continuing  Requirements  1456  Article  5. 

Physical  Environment 1456.4  Article  6.     - 

Scliool-Age  Child  Care  Article  7. 

Center 1456.6  Subchapter  2. 

General  Requirements  and 

Definitions 1456.6  Subchapter  3. 

Licensing  (Reserved)  1456.6 

Application  Procedures  1456.6  ^m-^it.  i. 

Enforcement  Provisions  Chapter  2. 

(Reserved) 1456.6  Article  1 . 

Administrative  Actions  Article  2. 

(Reserved) 1456.6 

Continuing  Requirements  1456.6  Article  3. 

Child  Care  Center  for 

Mildly  111  Children 1456.8  Article  4. 

General  Requirements  and  Article  5. 

Definitions 1456.8  Article  6. 

Licensing 1456.9  Chapter  3. 

Application  Procedures  1456.9  Article  1. 

Administrative  Actions  Article  2. 

(Reserved) 1456.10 

Enforcement  Provisions  Chanter  4 

(Reserved) 1456.10 

Continuing  Requirements  1456.10 

Chapters. 

Physical  Environment 1456.15 

Family  Day  Care  Homes  for  Chapter  6. 

Children 1456.17  ^^j^^j^  ^ 

General  Requirements  and  Subchapter  6  1 

Definitions 1456.17 

Licensing 1456.18  Article  L 

Application  Procedure  1457  Article  2. 

Enforcement  Provisions 1463 

Administrative  Actions 1464.1  Article  3. 

Continuing  Requirements  1465  Article  4. 

Physical  Environment  Chapter  7. 

(Reserved) 1466.5  Article  L 

^                       ,  ^.  ..  .  ^  Article  2. 
Department  of  Child  Support 

Services  1467  Article  3. 

Article  4. 
Program  Administration  1467 

Operations 1467  Article  5. 

Definitions 1467 

(Reserved) 1472.10(a)  Article  6. 

Plans  of  Cooperation 1472.10(a)  Chapter  8. 


Title  Table  of  Contents 

Page 

Standards  for  Local  Program 
Operations  (Reserved) 1472.10(b)(1) 

Records  Management  1472.10(b)(1) 

Customer  Service  1472.10(b)(2) 

Staff  Requirements 1472.10(b)(3) 

Fiscal  Administration 

(Reserved) 1472.10(b)(4) 

Administrative 

Reporting 1472.10(b)(4) 

Administrative  Reports 1472.10(b)(4) 

Case  Intake 1472.10(b)(5) 

Definitions 1472.10(b)(5) 

Application  and 

Referral 1472.10(b)(6) 

Case  Opening 

Requirements 1472.10(b)(6) 

Case  Processing 1472.10(b)(7) 

Cooperation   1472.10(b)(8) 

Family  Violence  1472.10(b)(9) 

Locate 1472.10(c) 

Locate  Requirements 1472.10(c) 

Federal  Parent  Locator 

Service  1472.10(d) 

Establishing  Paternity 

(Reserved) 1472.10(e) 

Review  and  Adjustment  of 

Child  Support  Orders  1472.10(e) 

Enforcement  Actions  I472.l0(i) 

Definitions I472.l0(i) 

Immediate  Enforcement 

Actions 1472.100) 

Income  Withholding  Orders  . . .  I472.i0(j) 

Medical  Support 

Enforcement 1472.  I0(k) 

Real  Property  Liens I472.l0(m) 

Credit  Reporting 1472. I0(o) 

Interstate  Cases I472.l0(p) 

Definitions I472.10(p) 

Long  Arm  Jurisdiction  1472.12 

General  Provisions 1472.12 

California  As  Initiating 

State 1472.14 

California  As  Responding 

State 1472.16 

Limited  Interstate  Services 1472.17 

Case  Closure  1472.17 


Article  5. 

Article  6. 

Article  7. 

Subchapter  3 

Article  1. 

Article  2. 
Article  3. 
Article  4. 

Article  5. 

Article  6. 
Subchapter  4 

Article  1. 

Article  2. 
Article  3. 
Article  4. 

Article  5. 


Article  6. 

Article  7. 

Chapter  3. 

Article  1. 

Article  2. 

Article  3. 

Article  4. 

Article  5. 

Article  6. 

Article  7. 

Division  13. 

Chapter  L 

Subchapter  1 

Article  L 

Article  2. 

Article  3. 

Page  xxiii 


(7-18-2008) 


Title  Table  of  Contents 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


Page 

Article  1.  Definitions 1472.17 

Article  2.  Case  Closure 1472.18 

Chapter  9.  Collection  and  Distribution  of 

Child  Support 1472.20 

Article  1.  Definitions 1472.20 

Articles.  General  Requirements 1472.21 

Article  6.  Compromise  of  Assigned 

Arrearages  —  Family 

Reunification  1472.21 

Chapter  10.  Complaint  Resolution 1472.23 


Page 

Article  1.  Definitions 1472.23 

Article  2.  Local  Complaint  Resolution 

Process  1472.24 

Article  3.  State  Hearing  1473 

Chapter  11 .  Quality  Control 1483 

Article  1.  Perfomiance  Measures 1483 

Chapter  12.  Automation  Requirements 

(Reserved) 1485 

Chapter  13.  Conflict  of  Interest  Code 1485 


Page  xxiv 


(7-18-2008) 


i&. 


Barclays  Official 

California 

Code  of 
Regulations 


Title  22.     Social  Security 

Division  3.     Health  Care  Services 


Vol.  29 


XMOIVISOIM 

* ^ 

\A/EST 


Barclays  Official  California  Code  of  Regulations 

425  Market  Street  •  Fourth  Floor  •  San  Francisco,  CA  94105 
800-888-3600 


Title  22 


Health  Care  Services 


Table  of  Contents 


Division  3.     Health  Care  Services 


Table  of  Contents 


Page 


Page 


Subdivision  1. 


California  Medical  Assistance 

Program 307 


Chapter  1.             ] 

[ntroduction  307 

§  50000. 

Meaning  of  Words. 

§50001. 

Department. 

§  50002. 

Director. 

§  50003. 

Medi-Cal  Program. 

§  50004. 

Medi-Cal  Program  Administration. 

§  50005. 

Medi-Cal  Regulations. 

§  50006. 

Conformity  with  Federal 

Requirements. 

§  50007. 

Fiscal  Intermediary. 

§  50008. 

Liens. 

§  50009. 

Medi-Cal  Consultant. 

§50009.1. 

Medical  Review. 

§  50009.2. 

Medical  Review  Team. 

§  50009.3. 

Health  Care  Services. 

Chapter  2. 


Determination  of  Medi-Cal 

Eligibility  and  Share  of  Cost  308 


icle  1. 

Definitions,  Abbreviations 

and  Program  Terms  308 

§50011. 

Definitions — General. 

§  50012. 

Abbreviations. 

§  50013. 

Adequate  Consideration. 

§  50014. 

Adult. 

§50015. 

Adverse  Action. 

§  50016. 

Aid. 

§  50017. 

Aid  Category. 

§50018. 

Aid  Code. 

§  50019. 

Aid  to  Families  with  Dependent 

Children  (AFDC). 

§  50020. 

Aid  to  the  Potentially 

Self-Supporting  Blind  (APSB). 

§50021. 

Applicant. 

§  50022. 

Application. 

§  50023. 

Approval  of  Eligibility. 

§  50024. 

Beneficiary. 

§  50025. 

Benefits  Review  Unit  (BRU). 

§  50025.3. 

Board  and  Care. 

§  50025.5. 

Burial  Insurance. 

§  50025.6. 

California  Standard  Nomenclature 

(CSN),  1979. 

§  50026. 

Cash  Grant. 

§  50027. 

Certification  Date  for  Claims 

Clearance. 

§  50028. 

Certification — Effective  Date. 

§  50029. 

Certification  for  Medi-Cal. 

§  50029.5. 

Certified  Long-Term  Care 

Insurance  Policy  or  Certificate. 

§  50030. 

Child. 

§50031. 

Child  Health  and  Disability 

Prevention  Program  (CHDP). 

§  50032. 

Competent. 

§  50033. 

Contiguous  Property. 

§  50034. 

Conversion  of  Property. 

§  50035. 

County  Agency. 

§  50035.5. 

County  Cash-Based  Medi-Cal 

Eligibility. 

§  50036. 

County  Department. 

§  50036.5. 

County  Case  Error  Rate. 

§  50036.6. 

Dependent  Relative. 

§  50037.  Eligibility  and  Assistance  Standards 

Manual  (EAS). 

§  50037.5.  Eligibility  Quality  Control. 

§  50038.  Eligibility  Services. 

§  50038.5.  Emergency  Assistance  (EA). 

§50039.  Encumbrances  of  Record. 

§  50040.  Fair  Market  Value. 

§50041.  Family  Member. 

§  50041 .5.  Federal  Poverty  Level. 

§50042.  Foster  Child. 

§  50043.  Heirloom. 

§  50044.  Home. 

§  50045.  Immigration  and  Naturalization 

Service  (INS). 

§  50045.1.  Impairment  Related  Work  Expenses 

(IRWE). 

§  50045.3.  Income  and  Eligibility  Verification 

System. 

§  50045.5.  In-Home  Supportive  Services. 

§  50046.  Inmate. 

§  50047.  Institution. 

§  50048.  Institution — Medical. 

§  50049.  Institution — Mental  Diseases. 

§  50050.  Institution — Nonmedical. 

§50051.  Institution — Private. 

§  50052.  Institufion— Public. 

§  50052.5.  Institution — Tuberculosis. 

§  50053.  Intraprogram  Status  Change. 

§  50054.  Interprogram  Transfer. 

§  50054.5.  Life  Insurance. 

§  50054.7.  Limited  Service  Status. 

§  50055.  Linked. 

§  50056.  Long-Term  Care  (LTC). 

§  50057.  Marriage. 

§  50058.  Medi-Cal. 

§  50059.  Medi-Cal  Card. 

§  50059.5.  State  Dollar  Error  Rate. 

§  50059.6.  Federal  Standard. 

§  50059.7.  State  Caused  Errors. 

§  50060.  Medi-Cal  Family  Budget  Unit 

(MFBU). 

§  50060.5.  Medi-Cal-Only  Eligibility. 

§  50060.6.  Medical  Support. 

§  50061.  Medically  Indigent  (MI)  Person  or 

Family. 

§  50062.  Medically  Needy  (MN)  Person  or 

Family. 

§  50063.  Minimum  Basic  Standard  of 

Adequate  Care  (MBSAC). 

§50063.5.  Minor  Consent  Services. 

§  50064.  Multiple  Dwelling  Unit. 

§  50064.5.  Nonrecurring  Lump  Sum  Payment. 

§  50065.  Obligate. 

§  50066.  Other  Public  Assistance  (Other  PA) 

Recipient. 

§  50067.  Overpayment. 

§  50068.  Parent. 

§  50068.5.  Parent— Minor. 

§  50069.  Parents — Unmarried. 

§  50069.5.  Parent — Unmarried  Minor. 

§  50070.  Patient. 

§  50071 .  Persons  Living  in  the  Home. 

§  50071.5.  Prepaid  Health  Plan. 

§  50071 .6.  Prepaid  Health 

Plan — Comprehensive. 


Page 


(7-18-2008) 


Table  of  Contents 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


Page 

§  50071.8.  Primary  Care  Case  Management 

(PCCM)  Plan. 

§  50072.  Property — Corrununity. 

§  50073.  Property — Personal. 

§  50074.  Property— Real. 

§  50075.  Property — Separate. 

§  50076.  Property — Share  of  Community. 

§  50077.  Public  Agency. 

§  50078.  Public  Assistance  (PA)  Recipient. 

§  50079.  Public  Funds. 

§  50079.5.  Publicly  Operated  Community 

Residence. 

§  50079.6.  Qualified  Disabled  and  Working 

Individual. 

§  50079.7.  Qualified  Medicare  Beneficiary. 

§50080.  Quality  Control. 

§50081.  Reapplication. 

§  50082.  Recipient. 

§  50083.  Redetermination. 

§  50084.  Relative. 

§  50085.  Relative— Caretaker. 

§  50086.  Repayment. 

§  50087.  Residence. 

§  50088.  Responsible  Relative. 

§  50089.  Restoration. 

§50090.  Share  of  Cost. 

§50091.  Share  of  Encumbrances. 

§  50091.5.  Specified  Low-Income  Medicare 

Beneficiary. 

§  50092.  Spenddown. 

§  50093.  State  Data  Exchange  (SDX). 

§  50094.  Steppai-ent. 

§  50095.  Supplemental  Security  Income/State 

Supplemental  Program  (SSI/SSP). 

§  50095.1 .  Title  11  Disregard  Person. 

§  50095.5.  Therapeutic  Wages. 

§  50095.7.  Title  II  Disregard  Person. 

§  50096.  Transfer  of  Property. 

§  50097.  Verification. 

Article  2.  Administration 317 


Page 


§  50127.  Persons  with  a  Guardian. 

§  50129.  County  of  Responsibility — Persons 

Placed  in  State  Hospitals  by  County 
Mental  Health  Agencies  or  Regional 
Centers  for  the  Developmentally 
Disabled. 


§50101. 

County  Department 
Responsibilities. 

§50103. 

Civil  Service  or  Merit  Systems. 

§  50105. 

Staffing  Requirements. 

§50106. 

Staff  Training. 

§  50107. 

Civil  Rights. 

§50109. 

Reports. 

§50110. 

Medi-Cal  Case. 

§50111. 

Case  Records  and  Confidentiality. 

§50113. 

Forms. 

§50115. 

Quality  Control — County 
Cooperation. 

§50116. 

Medi-Cal  Fiscal  Penalties. 

§50116.5. 

Appeal  of  Quality  Control  Review 
Findings. 

§50117. 

Calculation  of  Medi-Cal  Fiscal 
Penalties. 

§50118. 

Application  of  Medi-Cal  Fiscal 
Penalties. 

§50118.5. 

Reconsideration  of  a  Medi-Cal 
Fiscal  Penalty. 

§50119. 

County  Corrective  Action 
Requirements. 

icle  3. 

County  of  Responsibility  for 

Determination  of  Medi-Cal 

Elio 

ibilitv 

§  50120.  County  of  Responsibility. 

§  50121.  Persons  Eligible  Under  SSI/SSP 

§  50123.  County  of  Responsibility — Persons 

with  a  Family. 
§  50125.  County  of  Responsibility — Persons 

with  No  Family. 
§  50126.  County  of  Responsibility — Persons 

Eligible  Under  Special  Programs. 


§50131. 

Placement  in  Long-Term  Care  After 

Release  from  a  State  Hospital. 

§50133. 

County  of 

Responsibility — Deceased  Persons. 

§50134. 

County  of  Responsibility — Persons 

Absent  from  the  State. 

§50135. 

Application  Made  in  County  Other 

Than  County  of  Responsibility. 

§  50136. 

Intercounty  Transfer  Procedure. 

§50137. 

Intercounty  Transfer — Effective 

Date  of  Disconiinuance/Eligibility. 

§  50138. 

Intercounty  Transfer — Blindness  or 

Disability  Deterini nation  Pending. 

Article  4. 

Beneficiary  Application 

Process  

§50141. 

Application  Process — General. 

§50142. 

Screening. 

§50143. 

Persons  Who  May  File  an 

322 


§  50145. 


§50146. 


§  50147. 
§50147.1. 
§  50148. 

§  50149. 
§50151. 
§  50153. 

§50155. 


§  50157. 
§50159. 
§50161. 
§  50163. 

§  50165. 
§  50166. 


§  50167. 
§  50167.2. 

§  50167.5. 


§  50168. 
§50169. 

§50171. 
§50172. 
§50173. 
§50175. 


§50176. 
§  50177. 
§50179. 


Application  for  Medi-Cal. 

Medi-Cal  Application  for  Persons 

Applying  for  a  Cash  Grant  or 

In-Home  Supportive  Services. 

Medi-Cal  Application  for  Persons 

Applying  for  In-Home  Supportive 

Services. 

Application  for  Medi-Cal  Only. 

Child  Applying  for  Medi-Cal. 

Apphcation  for  Retroactive 

Medi-Cal. 

Apphcation  Form. 

Date  of  the  Apphcation. 

Medi-Cal  Apphcation — Process  for 

All  Programs. 

Withdrawal  of 

Application — Request  for 

Discontinuance. 

Face-to-Face  Interview. 

Statement  of  Facts. 

Statement  of  Facts  Form. 

Persons  Who  May  Complete  and 

Sign  the  Statement  of  Facts. 

Filing  the  Statement  of  Facts. 

Obtaining  Information  for  the 

Completion  of  the  Statement  of 

Facts. 

Verification — Prior  to  Approval. 

Verification  of  Income — lEVS 

Requirements. 

Verification  of  Unearned  Income 

Information  from  Internal  Revenue 

Service  (IRS)  or  Franchise  Tax 

Board  (FTB) — lEVS  Requirements. 

Verification — Within  60  Days. 

Additional  Verification 

Requirements. 

Clarification  of  Statement  of  Facts. 

Verification  by  Signature. 

Eligibility  Determination. 

Denial  or  Discontinuance  Due  to 

Lack  of  Information, 

Noncooperation  or  Loss  of  Contact. 

Discontinuance  Due  to  Death. 

Promptness  Requirement. 

Notice  of  Action — Medi-Cal-Only 

Determinations  or 

Redeterminations. 


Page  ii 


(7-18-2008) 


Title  22 


Health  Care  Services 


Table  of  Contents 


§50179.3. 

§50179.7. 

§  501 80. 

§50181. 

§50182. 

§50183. 
§  50183.5. 

§50184. 
§50185. 

§  50185.5. 


§50186. 
§50187. 

§50189. 

§  50191. 
§  50192. 


§  50193. 
§  50195. 
§  50197. 
§  50199. 

Article  5. 

§50201. 
§  50203. 
§  50205. 
§  50207. 

§  50209. 
§50211. 

§  50213. 
§  50215. 
§  50216. 

§  50216.5. 

§  50217. 
§  50219. 
§50221. 
§  50223. 
§  50227. 

§  50237. 
§50241. 
§  50243. 
§  50244. 
§  50245. 

§  50247. 

§  50249. 
§50251. 
§  50253. 
§  50255. 
§  50256. 

§  50257. 


Page 

Notice  of  Action — County  Cash 

Assistance  Determinations  or 

RedeteriTiinations  Which  Affect 

County  Cash-Based  Medi-Cal 

Eligibility. 

Notice  of  Action — Medi-Cal 

EUgibility  of  SSI/SSP  Recipients. 

Action  Prior  to  Denial  of 

Application. 

Action  Following  Denial  of  an 

SSI/SSP  Application. 

Corrective  Action  on  Denied 

Applications. 

Transfer  Between  Programs. 

Action  Following  Medi-Cal 

Discontinuance  by  the  Department. 

RefeiTal  for  Social  Services. 

Applicants'  and  Beneficiaries' 

General  Responsibilities. 

Medi-Cal  Managed  Care  Plan 

Assigned  Enrollment  Prior  to 

Two-Plan  Model  Implementation  or 

for  Geographic  Areas  Not 

Designated  for  Two-Plan  Model 

Implementation. 

Unconditionally  Available  Income. 

Social  Security  Numbers  and  Health 

Insurance  Claim  Numbers. 

Redetermination — Frequency  and 

Process. 

Status  Reports. 

Testing  Techniques  for 

Redeterminations,  Status  Reporting 

and  Verification. 

Beginning  Date  of  Eligibility. 

Period  of  Eligibility. 

Retroactive  Eligibility. 

Certification  for 

Medi-Cal — Completion . 

Medi-Cal  Programs 336.7 

Medi-Cal  Programs — General. 

Medically  Needy  Program. 

Linkage  to  AFDC. 

Deprivation — ^Relinquishment  for 

Adoption. 

Deprivation — Deceased  Parent. 

Deprivation — Physical  or  Mental 

Incapacity  of  a  Parent. 

Deprivation — Absent  Parent. 

Deprivation — Unemployed  Parent. 

Good  Cause — Refusal  of 

Employment. 

Linkage  to  AFDC — Placement  in 

Foster  Care. 

Linkage  to  SSI/SSP 

Blindness. 

Age. 

Disability. 

Public  Assistance  Cash  Grant 

Programs. 

Other  Public  Assistance  Program. 

Children  Not  in  School  or  Training. 

Four  Month  Continuing  Eligibility. 

Nine  Month  Continuing  Eligibihty. 

In-Home  Supportive  Services 

(IHSS). 

Twenty  Percent  Social  Security 

Increase. 

Medically  Needy  Program. 

Medically  Indigent  Program. 

Miscellaneous  Special  Programs. 

Repatriate  Program. 

Qualified  Disabled  and  Working 

Individual  Program. 

Refugee  Medical  Assistance  (RMA) 

and  Entrant  Medical  Assistance 

(EMA). 


Page 


§  50258. 

Qualified  Medicare  Beneficiary 

Program. 

§50258.1. 

Specified  Low-Income  Medicare 

Beneficiary  Program  (SLMB). 

§  50259. 

Indochinese  Refugee  Status. 

§  50260. 

60-Day  Postpartum  Services 

Program. 

§  50261 . 

Special  Medi-Cal  Dialysis 

Programs. 

§  50262. 

Special  Zero  Share  of  Cost 

Programs  for  Pregnant  Women  and 

Infants. 

§  50262.3. 

Continued  Eligibility  Program  for 

Pregnant/Postpartum  Women  and 

Infants. 

§  50262.5. 

Special  Zero  Share  of  Cost  Program 

for  Children  of  Age  One  Up  to  Age 

Six  (133  Percent  Program). 

§  50262.6. 

Special  Zero  Share  of  Cost  Program 

for  Children  of  Age  Six  Up  to  Age 

Nineteen  (100  Percent  Program). 

§  50262.7. 

Targeted  Case  Management 

Services  Program. 

§  50263. 

MC  800  Program. 

§  50264. 

Medi-Cal  Special  Treatment 

Programs. 

§  50265. 

Medi-Cal  Aid  Codes. 

§  50268. 

Tuberculosis  (TB)  Program. 

e6. 

Institutional  Status  

341 

§  50271.  Institutional  Status — General. 

§  50273.  Medi-Cal  Ineligibility  Due  to 

Institutional  Status. 
§  50275.  Voluntary  Inmates. 

§  50279.  Limitations  of  Institutional  Status. 

Article  7.  Alienage,  Citizenship  and 

Residence 342 


§  50301. 

Citizenship  or  Immigration  Status 

for  Full  Medi-Cal  Benefits. 

§50301.1. 

Documentation  of  Status  as  a 

Citizen  or  National  of  the  United 

States. 

§50301.2. 

Documentation  of  Status  as  an  AUen 

Lawfully  Admitted  for  Permanent 

Residence. 

§50301.3. 

Documentation  of  Status  as  an  Alien 

Permanently  Residing  in  the  United 

States  Under  Color  of  Law 

(PRUCOL). 

§50301.4. 

Documentation  of  Status  as  an 

Amnesty  AUen. 

§50301.5. 

Opportunity  to  Document 

Satisfactory  Immigration  Status. 

§  50301.6. 

Verification  of  Satisfactory 

Immigration  Status. 

§  50302. 

Restricted  Medi-Cal  Benefits  for 

Certain  Aliens. 

§50302.1. 

Limitations  on  Medi-Cal  Benefits 

for  Aliens. 

§  50302.2. 

Limitations  on  Medi-Cal  Benefits 

for  Aliens. 

§  50303. 

Alien  Status  Verification. 

§  50304. 

Written  Declaration  of  Status  as  a 

Citizen  of  the  United  States,  a 

National  of  the  United  States,  or  an 

Alien. 

§  50305. 

Documentation  of  an  Alien's  Legal 

Status. 

§  50310. 

WR  6  Procedure. 

§50311. 

Lawful  Presence  in  the  United 

States. 

§  50313. 

Legal  Entry  for  a  Limited  Period. 

§  50320. 

California  Residence— General. 

§50320.1. 

California  Residence — Evidence. 

§  50320.2. 

California  Residency — County 

Verification. 

§50321. 

Temporary  Absence  from  the  State. 

Page  iii 


(7-18-2008) 


Table  of  Contents 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


Page 


Page 


§  50323. 

Absence  from  the  State  for  More 

Than  60  Days. 

§  50325. 

Death  During  Absence  from  the 

State. 

§  50327. 

Persons  Living  on  Land  Leased  or 

Owned  by  the  United  States. 

§  50329. 

Persons  on  Parole  from  Correctional 

or  Other  Institutions. 

§50331. 

United  States  Citizen  Children  of 

Aliens. 

§  50333. 

Foster  Children  and  Institutionalized 

Persons  Placed  Out-of-State. 

§  50334. 

Out-of-State  Foster  Children  and 

Institutionalized  Persons  Placed  in 

California. 

§  50336. 

Other  Persons  in  Out-of-State 

Institutions. 

§  50338. 

Other  Persons  in  California 

Institutions. 

Article  8. 

Responsible  Relatives  and 

Unit  Determination  348 

§50351. 

Responsible  Relatives. 

§50371. 

Medi-Cal  Family  Budget  Unit. 

§  50373. 

Medi-Cal  Family  Budget  Unit 

Determination,  No  Family  Member 

in  LTC  or  Board  and  Care. 

§  50374. 

MFBU  Determination— Child  Stays 

Alternately  with  Each  Parent. 

§  50375. 

Medi-Cal  Family  Budget  Unit 

Determination,  Stepparent  Cases. 

§  50377. 

Medi-Cal  Family  Budget  Unit 

(MFBU)  Deternunation,  Family 

Member  in  Long-Term  Care  or 

Board  and  Care. 

§  50379. 

Ineligible  Members  of  the  Medi-Cal 

Family  Budget  Unit. 

§  50381. 

Persons  Excluded  from  the 

Medi-Cal  Family  Budget  Unit. 

Article  9. 

Property  350.3 

§  50401. 

Property  Evaluation. 

§  50402. 

Availability  of  Property. 

§  50403. 

Treatment  of  Property:  Separate  and 

Community  Property. 

§  50404. 

Owner  of  Propeity. 

§  50405. 

Contracts  of  Sale. 

§  50406. 

Conversion  or  Transfer  of  Property. 

§  50407. 

Conversion  of 

Property — Treatment. 

§  50408. 

Transfer  of  Property  Which  Does 

Not  Result  in  Ineligibility. 

§  50409. 

Transfer  of  Property  Which  Results 

in  Ineligibility. 

§  50410. 

Transfer  of  Property  with  Retention 

of  a  Life  Estate. 

§  50411. 

Period  of  Ineligibility  Due  to 

Transfer  of  Property. 

§  50412. 

Market  Value  of  Property. 

§  50413. 

Encumbrances. 

§  50414. 

Share  of  Encumbrances 

Determination. 

§  50415. 

Net  Market  Value  of  Property. 

§  50416. 

Utilization  Requirements. 

§50417. 

Utilization — Good  Cause. 

§  50418. 

Exemption  of  Property. 

§  50419. 

Property  Reserve. 

§  50420. 

Property  Limit. 

§  50420.5. 

Separation  of  Community  Property: 

Spouse  in  Long-Term  Care  Facility. 

§50421. 

Limits  and  Methods  of  Property 

Determination  for  the  Qualified 

Medicare  Beneficiary  (QMB)  or  the 

Specified  Low-Income  Medicare 

Beneficiary  (SLMB). 

§50421.5. 


§  50422. 
§  50423. 
§  50425. 

§  50426. 

§  50427. 
§  50428. 
§  50429. 

§50431. 

§  50433. 

§  50435. 

§  50437. 

§  50441. 

§  50442. 
§  50443. 

§  50445. 

§  50446. 

§  50448. 

§  50448.5. 
§  50449. 
§50451. 
§  50453. 
§  50453.5. 
§  50453.7. 

§  50454. 
§  50454.5. 

§  50455. 
§  50456. 
§  50457. 
§  50459. 
§50461. 
§  50463. 
§  50465. 
§  50467. 
§  50469. 
§50471. 
§  50473. 
§  50475. 
§  50476. 
§  50477. 
§  50479. 
§  50481. 

§  50483. 
§  50485. 
§  50487. 
§  50489. 
§50489.1. 
§  50489.5. 

§  50489.9. 

Article  10. 

§50501. 
§  50503. 
§  50505. 


Limits  and  Methods  of  Property 

Determination  for  the  Qualified 

Disabled  and  Working  Individual 

(QDWI). 

Liens. 

Items  of  Property  to  Be  Considered. 

Property  Used  As  a  Principal 

Residence. 

Property  Used  to  Purchase  a 

Principal  Residence. 

Other  Real  Property. 

Liens. 

Value  and  Division  of  Real  Property 

Where  Part  Is  Used  As  a  Home. 

Land  Contiguous  to  the 

Home — Value  and  Division. 

Single  Family  Dwelling  Used  in 

Part  As  a  Business — Value  and 

Division. 

Multiple  Dwelling  Unit — Value  and 

Division. 

Land  with  More  Than  One 

Building — Value  and  Division. 

Mortgages,  Deeds  of  Trust  and 

Other  Promissory  Notes. 

Life  Estate. 

American  Indian's  Interest  in  Land 

Held  in  Trust  by  United  States 

Government. 

Federal  Payments  to  Indians  and 

Alaskan  Natives — Property. 

Payments  to  Victims  of  the  National 

Socialist  Persecution. 

Payments  to  Victims  of 

Crimes — Treatment  as  Property. 

Relocation  Assistance  Benefits. 

Earned  Income  Tax  Credit. 

Cash  on  Hand. 

Checking  and  Savings  Accounts. 

Savings  of  a  Child. 

Long-Term  Care  Insurance 

Exemption. 

Income  Tax  Refunds. 

California  Franchise  Tax  Board 

Payments. 

Lump  Sum  Payments. 

Stocks,  Bonds,  Mutual  Funds. 

United  States  Savings  Bonds. 

Promissory  Notes. 

Motor  Vehicles. 

Boats,  Campers,  Trailers. 

Household  Items. 

Personal  Effects. 

Recreational  Items. 

Musical  Instruments. 

Livestock  and  Poultry. 

Life  Insurance. 

Burial  Insurance. 

Burial  Plots,  Vaults  and  Crypts. 

Burial  Funds. 

Disaster  and  Emergency  Assistance 

Payments. 

Loans. 

Business  Property. 

Stocks  Held  by  Natives  of  Alaska. 

Trusts — General. 

Medicaid  Qualifying  Trusts. 

OBRA  93  Trusts  Established  On  or 

After  August  II,  1993. 

Trusts  Other  than  Those  Described 

in  50489.1  or  50489.5. 

Income  362.2 

Income — General. 

Gross  Earned  Income. 

Net  Profit  from  Self-Employment. 


Page  iv 


(7-18-2008) 


Title  22 


Health  Care  Services 


Table  of  Contents 


Page 


Page 


§  50507.  Gross  Unearned  Income. 

§  50508.  Net  Income  from  Property. 

§50509.  Income  in  Kind. 

§  5051 1 .  Value  of  Income  in  Kind. 

§50512.  Ownership  of  Income. 

§50513.  Availability  of  Income. 

§  50515.  Unavailable  Income. 

§  505 17.  Apportionment  of  Incoine  over 

Time. 
§  505 17.1.  Apportionment  of  Income 

Exemptions  and  Deductions. 
§  505 18.  Fl  uctuati  ng  Income . 

§  50519.  Income  Exemptions  and 

Deductions — General. 
§  50521.  Payments  Exempt  from 

Consideration  as  Income. 
§  50523.  Property  Tax  Refunds. 

§  50523.5.  California  Franchise  Tax  Board 

Payments. 
§  50524.  Child/Spousal  Support  Received  by 

AFDC-MN  and  MI  Family 

Members. 
§  50525.  Public  Assistance  and  General 

Relief  Grants. 
§  50526.  Work  Incentive  Program  (WIN). 

§  50527.  Social  Services. 

§  50528.  Assistance  Based  on  Need. 

§  50529.  Federal  Housing  Assistance. 

§  50530.  Training  Expenses. 

§  5053 1 .  Foster  Care  Payments. 

§  50533.  Exempt  Loans,  Grants,  Scholarships 

and  Fellowships. 
§  50534.  Payments  to  Victims  of 

Crimes — Treatment  as  Income. 
§  50535.  Relocation  Assistance  Benefits. 

§  50535.5.  Disaster  and  Emergency  Assistance 

Payments. 
§  50536.  Payments  to  Victims  of  the  National 

Socialist  Persecution. 
§  50537.  Federal  Payments  to  Indians  and 

Alaskan  Natives — Income. 
§  50538.  VISTA  Payments. 

§  50539.  Job  Training  Partnership  Act  (JTPA) 

Payments. 
§  50540.  Executive  Volunteer  Programs. 

§  50541 .  Senior  Citizen  Volunteer  Programs. 

§  50542.  Irregular  or  Infrequent  Income. 

§  50543.  Student  Exemption. 

§  50543.5.  Earned  Income  Tax  Credit. 

§  50544.  Earnings  of  Children  Under  Age  1 4. 

§  50545.  Deductions  from  Income. 

§  50547.  Educational  Expenses. 

§  50549.  Deductions  from  Income — MFBUs 

Which  Include  Aged,  Blind  or 

Disabled  MN  Persons. 
§  50549.1 .  Support  Payment  from  an  Absent 

Parent. 
§  50549.2.  Any  Income  Deduction — Unearned 

Income. 
§  50549.3.  Guardian  and  Conservator  Fees. 

§  50551.  Student  Deduction. 

§  50551.1.  Thirty  Dollars  Plus 

One-Third— MFBUs  Which 

Include  Aged,  Blind  or  Disabled 

MN  Persons. 
§  50551 .2.  Any  Income  Deduction — Earned 

Income. 
§  50551 .3.  Sixty-Five  Plus  One-Half. 

§  5055 1 .4.  Work  Expenses  of  the  Blind. 

§  50551.5.  Income  Necessary  to  Achieve 

Self-Support. 
§  50551.6.  Cost  of  In-Home  Supportive 

Services— ABD-MN  and  SGA 

Disabled. 
§  50553.  Deductions  from  Earned 

Income— AFDC-MN,  MI  or 

Ineligible  Members  of  the  MFBU. 


§50553.1. 

Deduction  for  Work  Expenses. 

§  50553.2. 

Deduction  for  Dependent  Care. 

§  50553.3. 

Thirty  Dollars  Plus  One-Third. 

§  50553.5. 

Deduction  for  Dependent  Care. 

§  50554. 

Court  Ordered  Alimony  or  Child 

Support. 

§  50554.5. 

Child/Spousal  Support  Received  by 

AFDC-MN  and  MI  Family 

Members. 

§  50555. 

Deductions  from  Any  Income — All 

MN  or  Ml  Programs. 

§  50555.1. 

Income  of  an  MN  or  Ml  Person 

Used  to  Determine  Public 

Assistance  Eligibility  of  Another 

Family  Member. 

§  50555.2. 

Health  Insurance  Premiums. 

§  50555.3. 

Court  Ordered  Child  Support. 

§  50555.4. 

Special  Deduction  for  Aged,  Blind 

or  Disabled  MN. 

§  50557. 

Treatment  of  Income. 

§  50558. 

Income  of  Persons  Excluded  from 

the  MFBU. 

§  50559. 

Income  Deemed  Available  from  the 

Stepparent. 

§  50561. 

Treatment — Stepparent  Cases. 

§  50563. 

Treatment  of  Income — Aged,  Blind 

or  Disabled  MN  Person  or  Person's 

Spouse  in  LTC  or  Board  and  Care. 

§  50564. 

Treatment  of  Income — Persons  No 

Longer  Receiving  Title  XVI  Due  to 

a  Cost  of  Living  Increase  in  OASDI 

Benefits  Under  Title  11. 

§  50565. 

Projection  of  Anticipated  Income. 

§  50567. 

Adjustment  for  Decreases  in 

Income. 

§  50569. 

County  Failure  to  Change  Income. 

§  50570. 

Income  Determination  and  Limit  for 

the  Qualified  Medicare  Beneficiary 

(QMB)  or  the  Specified 

Low-Income  Medicare  Beneficiary 

(SLMB). 

§  50571. 

Income  Determination  and  Limit  for 

the  Qualified  Disabled  and  Working 

Individual  (QDWI). 

Article  11. 

Maintenance  Need  

§50601. 

Maintenance  Need — General. 

§  50603. 

Maintenance  Need — Persons  Living 

in  the  Home. 

§  50604.  Maintenance  Need — Family 

Members  Maintaining  Separate 
Residences  with  Eligibility 
Determined  As  a  Single  MFBU. 

§  50605.  Maintenance  Need — Persons  in 

Long-Term  Care. 

Article  12.         Share  of  Cost  375 

§  5065 1 .  Share  of  Cost— General . 

§  50652 .  Share  of  Cost  Period . 

§  50653.  Determination  of  Share  of  Cost. 

§  50653.3.  Changes  Which  Decrease  the  Share 

of  Cost. 
§  50653.5.  Changes  Which  Increase  the  Share 

of  Cost. 
§  50653.7.  Changes  in  Share  of  Cost 

Determination  Due  to 

Administrative  Error. 
§  50655.  Record  of  Health  Care 

Costs — Share  of  Cost. 
§  50657.  Completion  of  Form  MC  177S. 

§  50658.  Form  MC  177S  Processing. 

§  50659.  Long-Term  Care  Patients  with  a 

Share  of  Cost. 
§  50660.  MFBUs  Which  Include  a  Title  II 

Disregard  Person. 

Article  13.         Period  of  Eligibility 378 

§  50701 .  Beginning  Date  of  Eligibility. 


Page  V 


(7-18-2008) 


Table  of  Contents 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


Page 

§  50703.  Period  of  Eligibility. 

§50710.  Retroactive  Eligibility. 

§  50715.  Certification  for 

Medi-Cal — Completion. 

Article  14.         Medi-Cal  Card  Use  and 

Issuance  379 

§  5073 1 .  Medi-Cal  Card  Use. 

§  50732.  Medi-Cal — Signature  Requirement. 

§  50733.  Medi-Cal  Card — Authorization  for 

Services. 
§  50735.  Locations  at  Which  Medi-Cal  Card 

May  Be  Used. 
§  50737.  Format  of  Medi-Cal  Card. 

§  50739.  Full  Complement  and  POE  Only 

Medi-Cal  Cards. 
§  50740.  Medi-Cal  Cards  for  Restricted 

Medi-Cal  Benefits  to  Certain 

Aliens. 
§  50741.  Medi-Cal  Caid  Issuance  by  the 

Department. 
§  50742.  Limitations  on  Eligibility  Reports 

and  Card  Issuance  Requests 

Submitted  by  the  County 

Department. 
§  50743.  Medi-Cal  Card  Issuance  by  the 

County  Department — No  Share  of 

Cost. 


§  50745. 

Medi-Cal  Card  Issuance  by  the 

County  Department — Share  of  Cost. 

§  50746. 

Limitation  on  Medi-Cal  Card 

Issuance. 

§  50749. 

Control  of  County  Issued  Medi-Cal 

Cards. 

§  50751. 

Report  of  Eligibles. 

icle  15. 

Other  Health  Care  Coverage 

and  Medicare  Buy-In 

Coverage  382 

§50761. 

Other  Health  Care 

Coverage — General. 

§  50763. 

Beneficiary  Responsibility — ^Other 

Health  Care  Coverage. 

§  50765. 

County  Department 

Responsibility — Other  Health  Care 

Coverage. 

§  50769. 

Department  Responsibility — Other 

Health  Care  Coverage. 

§  50771. 

Recovery  of  Third  Party  Payments. 

§50771.5. 

Determination  of  Good  Cause  for 

Refusal  to  Cooperate. 

§  50772. 

Veterans  Aid  and  Attendance 

Payments. 

§  50773. 

Medicare  Buy-in. 

§  50775. 

Medicare  Coverage. 

§  50777. 

Requirement  to  Apply  for 

Medicare. 

§  50778. 

Other  Health  Care  Coverage 

Premium  Payment. 

icle  16. 

Overpayments,  Fraud  and 

Improper  Utilization  386 

§50781. 

Potential  Overpayments. 

§50781.5. 

Potential 

Overpayments — Unreported  Other 

Health  Coverage. 

§  50782. 

Fraud. 

§  50783. 

County  Action  on  Potential 

Overpayment. 

§  50785. 

Action  on 

Overpayment — Department  of 

Health. 

§  50786. 

Action  on 

Overpayment — Department  of 

Health  Services  or  County  Unit 

Contracted  to  Collect 

Overpayments. 

Page 

§  50787.  Demand  for  Repayment. 

§  50789.  Failure  to  Repay. 

§50791.  Medi-Cal  Overpayments 

Fraud— AFDC  Cash  Grant. 
§  50793.  Utilization  Restrictions. 

Article  17.         Dialysis  Medi-Cal  Program 386.3 

§  50801 .  Medi-Cal  Special  Treatment 

Programs — General. 
§  50803.  Medi-Cal  Special  Treatment 

Programs  Beneficiary. 
§  50805.  Real  Property— Medi-Cal  Special 

Treatment  Programs 
§  50807.  Personal  Property— Medi-Cal 

Special  Treatment  Programs. 
§  50809.  Gross  Income — Medi-Cal  Special 

Treatment  Programs. 
§50811.  Annual  Net  Worth. 

§50813.  Percentage  Obligation. 

§  50815.  Application  Process — Medi-Cal 

Special  Treatment  Programs. 
§50817.  Eligibility 

Requirements — Medi-Cal  Special 

Treatment  Programs. 
§50819.  Verification 

Requirements — Medi-Cal  Special 

Treatment  Programs. 
§  50820.  Eligibility  Determination  for 

Medi-Cal  Special  Treatment 

Programs. 
§  5082 1 .  Medi-Cal  Special  Treatment 

Program. 
§  50823.  Beginning  Date  of 

Eligibility — Medi-Cal  Special 

Treatment  Programs. 
§  50825.  Determination  of  Annual  Net 

Worth. 
§  50827.  Determination  and  Application  of 

Percentage  Obligation — Medi-Cal 

Special  Treatment  Programs. 
§  50829.  Declaration  of  Acceptance. 

§  5083 1 .  Share  of  Cost— Medi-Cal  Special 

Treatment  Programs — Supplement 

Beneficiary. 

Article  18.         State  Administrative 

Hearings 389 

§  50951.  Right  to  State  Hearing. 

§  50953.  State  Hearing  Procedures. 

§  50955.  Fair  Hearing — Assistance  in  Filing. 

Article  19.         Medi-Cal  Estate  Recovery  390 

§  50960.  Definitions. 

Chapter  2.5.         Third  Party  Liability 390 

Article  1 .  Definitions 390 

§  50960.2,  Annuity. 

§  50960.4.  Applicant. 

§  50960.6.  Dependent. 

§  50960.9.  Equity  Interest. 

§50960.12.  Estate. 

§50960.15.  Estate  Hearing. 

§  50960.21 .  Fair  Market  Value. 

§  50960.23.  Heir. 

§  50960.26.  Irrevocable  Transfer. 

§  50960.29.  Life  Estate. 

§  50960.32.  Revocable  Transfer. 

§  50960.34.  Survivor. 

§  50960.36.  Voluntary  Post  Death  Lien. 

Article  2.  Estate  Recovery 392 

§50961.  Estate  Claims. 

§  50962.  Notification. 

§  50963.  Substantial  Hardship  Criteria. 

§  50964.  Estate  Hearing. 

§  50965.  Voluntary  Post  Death  Lien. 

§  50966.  Claim  Exemption. 


Page  vi 


(7-18-2008) 


Title  22 


Health  Care  Services 


Table  of  Contents 


Chapter  3. 

Article 

§ 
§ 
§ 
§ 


1. 

51000. 
51000. 
51000. 
51000. 
51000. 
51000. 
51000. 
51000. 
51000. 
51000. 

51000. 
51000. 
51000. 
51000. 
51000. 
51000. 
51000. 
51000. 
51000. 


Page 

Health  Care  Services 392.4 

Application  and  Enrollment  392.4 


Page 


1. 

1.1. 

2. 

3. 

4. 

5. 

6. 

6.1. 

7. 


9. 

10. 

10.1. 

11. 

12. 

13. 

14. 

15. 


§51000.15.1. 


51000. 
51000. 
51000. 

51000. 
51000. 
51000. 
51000. 
51000. 
51000. 
51000. 
51000. 
51000. 

51000. 
51000. 
51000. 
51000. 
51000. 


16. 
17. 
18. 

19. 

20. 

20.1. 

20.9. 

21. 

22. 

23. 

24. 

24.1. 

25. 

25.1. 

25.2. 

26. 

30. 


§51000.31. 


§  51000.32. 


Agent. 

Applicant. 

Application  or  Application  Package. 

Beneficiary. 

Business  Address. 

Business  Telephone. 

Capital. 

Change  of  Ownership. 

Deactivate. 

Enrolled  or  Enrollment  in  the 

Medi-Cal  Program. 

Group  Provider  Number. 

Indirect  Ownership  Interest. 

Line  of  Credit. 

Location. 

Mailing  Address. 

Managing  Employee. 

Ownership  Interest. 

Pay  To  Address. 

Person  with  an  Ownership  or 

Control  Interest. 

Preenrollment  Period  or 

PreenroUment. 

Provider  Group. 

Provider  Group  Applicant. 

Provider  Identification  Number  or 

PIN. 

Provider. 

Provider  Number. 

Provider  Transferor. 

Rendering  Practitioner. 

Rendering  Provider. 

Rendering  Provider  Number. 

Significant  Business  Transaction. 

Subcontractor. 

Successor  Liability  with  Joint  and 

Several  Liability. 

Supplier. 

Suspend. 

Transferee  Applicant. 

Wholly  Owned  Supplier. 

Medi-Cal  Provider  Application  for 

Enrollment,  Continued  Enrollment, 

or  Enrollment  at  a  New,  Additional, 

or  Change  in  Location. 

Medi-Cal  Provider  Group  or 

Rendering  Provider  Application  for 

Enrollment,  Continued  Enrollment 

or  Enrollment  at  a  New,  Additional 

or  Change  in  Location. 

Requirements  for  Successor 

Liability  with  Joint  and  Several 

Liability. 


§51003.1. 


§51003.3. 
§51003.7. 


Provider  Appeal  Process  for 

Treatment  Authorization  Requests 

(TARs). 

Prior  Authorization  of  Personal  Care 

Benefits. 

Prior  Authorization  Under  Primary 

Caie  Case  Management  Contracts. 


• 


§51000.35. 

Disclosure  Requirements. 

§  51000.40. 

Reporting  of  Additional  or  Changed 

Information  to  Provider 

Applications. 

§  51000.45. 

Provider  Agreement. 

§51000.50. 

Application  Review  Criteria  and 

Notice  of  Department  Action. 

§51000.51. 

Provisional  Provider  and  Preferred 

Provisional  Provider  Status. 

§  51000.52. 

Provider  Numbers. 

§  51000.53. 

Deactivation  of  a  Provider 

Number(s). 

§51000.55. 

Requirements  for  Continued 

Enrollment. 

§  51000.60. 

Established  Place  of  Business. 

Article  1.3. 

General  Provisions 394.  ii 

§51001. 

Beneficiary. 

§51002. 

Beneficiary  BiUing. 

§  51003. 

Treatment  Authorization  Requests 

(TARs). 

§51004. 

Copayment. 

§  51005. 

Other  Health  Care  Coverage. 

§51006. 

Out-of-State  Coverage. 

§51007. 

Discrimination. 

§51008. 

Bills  for  Service. 

§51008.1. 

Upper  Billing  Limit. 

§51008.5. 

Billing  Procedures  for  Claims 

Delayed  by  Good  Causes. 

§  51009. 

Confidential  Nature  of  Records. 

§51011. 

Identification  of  Beneficiary. 

§51011.1. 

Year  2000  Alternate  Procedure  for 

Verification  of  Eligibility. 

§51013. 

California  Children  Services. 

§  51014. 

Vocational  Rehabilitation  Services. 

§51014.1. 

Fair  Hearing  Related  to  Denial, 

Termination  or  Reduction  in 

Medical  Services. 

§  51014.2. 

Medical  Assistance  Pending  Fair 

Hearing  Decision. 

§51015. 

Provider  Grievances  and 

Complaints. 

§51015.1. 

Special  Claims  Review  Appeals. 

§51015.2. 

Providers  of  Personal  Care  Services 

Grievance  and  Complaints. 

Article  1.5. 

Provider  Audit  Appeals  396.3 

§51016. 

Definitions. 

§51017. 

Provider  Audit  Hearing. 

§51018. 

Home  Office — Chain  Organization 

Related  Entities. 

§51019. 

Amended  Cost  Reports. 

§  51020. 

Amended  Audit  Report. 

§51021. 

Exit  Conference  and  Audit  Report. 

§  51022. 

Request  for  Hearing. 

§51023. 

Informal  Level  of  Review. 

§51024. 

Request  for  Formal  Hearing. 

§51025. 

Notice  of  Formal  Hearing. 

§  51026. 

Department  Mailings. 

§  51027. 

Time  and  Place  of  Informal  Level  of 

Review  and  Formal  Hearing. 

§  51028. 

Merger  of  Successive  Requests  for 

Hearings. 

§51029. 

Consolidation  of  Proceedings. 

§51030. 

Hearing  Officer's  Authority. 

§51031. 

Severance  of  Issues. 

§  51032. 

Discovery. 

§51033. 

Subpoenas  and  Witnesses. 

§  51034. 

Depositions. 

§51035. 

Affidavits. 

§  51036. 

Preparation  for  Formal  Hearing. 

§  51037. 

Conduct  of  Formal  Hearing. 

§51038. 

Official  Notice. 

§  51039. 

Continued  or  Further  Hearings. 

§  51040. 

Evidence. 

§51041. 

Representation  at  a  Formal  Hearing. 

§  51042. 

Oral  Argument  and  Briefs. 

§51043. 

Disqualification  of  Hearing  Officer. 

§  51044. 

Decision. 

§51045. 

Reconsideration. 

§  51046. 

Judicial  Review. 

§51047. 

Recovery  of  Overpayments. 

§  51048. 

Administrative  Review  of 

Performance  Under  Selective 

Provider  Contracts. 

Article  1.6. 

Skilled  Nursing  Facility  and 

§51048.1. 


Intermediate  Care  Facility 
Certification  Appeals 

Procedure  

Limitations. 


402 


Page  vii 


(7-18-2008) 


Table  of  Contents 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


Page 


Page 


§5 

048.2 

§5 

048.3 

§5 

048.4 

§5 

048.5 

§5 

048.6 

§5] 

048.7 

§5] 

048.8 

§51 

048.9 

Article  2 

§51 

050. 

§5 

051. 

§5] 

052. 

§5] 

053. 

§5 

055. 

§51 

056. 

§5] 

056.1 

§51 

056.2 

§5] 

057. 

§51 

059. 

§5 

060. 

§5 

061. 

§5 

063. 

§5 

065. 

§5 

066. 

§5 

067. 

§5 

069. 

§5 

070. 

§5 

071. 

§5 

073. 

§5 

074. 

§5 

074.5 

§5 

1075. 

§5 

1077. 

§5 

1079. 

§5 

1081. 

§5 

1082. 

§5 

082.1 

§5 

1083. 

§5 

085. 

§5 

087. 

§5 

089. 

§5 

1090. 

§5 

091. 

§5 

093. 

§5 

094. 

§5 

094.1 

§5 

095. 

§5 

096. 

§5 

1097. 

§5 

098. 

§5 

098.5 

§5 

1099. 

§5 

1100. 

§5 

1101. 

§5 

1102. 

§5 

1103. 

§5 

104. 

§5 

1104.1 

§5 

1105. 

§5 

106. 

§5 

1107. 

§5 

1108. 

§5 

1109. 

§5 

no. 

§5 

no.i 

§5 

110.2 

§5 

110.3 

§5 

110.4 

§51 

111. 

§5 

112. 

Right  to  a  Reconsideration. 
Request  for  Reconsideration. 
Reconsidered  Determination. 
Right  to  Full  Evidentiary  Hearing. 
Request  for  a  Full  Evidentiary 
Hearing. 

Full  Evidentiary  Hearing. 
Termination  of  a  Provider. 
Remedies  Other  Than  Termination. 

Definitions 403 

Health  Care  Financing 

Administration's  Common 

Procedure  Coding  System. 

Provider. 

Blood  Bank. 

Physician. 

Physicians'  Services. 

Emergency  Services. 

Experimental  Services. 

Unlabeled  Use  of  Drugs. 

Dentist. 

Dental  Services. 

Dental  School  Clinic. 

Emergency  Dental  Services. 

Diagnostic  Dental  Services. 

Restorative  Dental  Services. 

Orthodontic  Dental  Services. 

Registered  Nurse. 

Licensed  Vocational  Nurse. 

Psychiatric  Technician. 

Chiiopractor. 

Chiropractic  Services. 

Acupuncturist. 

Acupuncture  Services. 

Podiatrist. 

Podiatry  Services. 

Physical  Therapist. 

Physical  Therapy. 

Respiratory  Care  Practitioner. 

Respiratory  Care  Practitioner 

Services. 

Occupational  Therapist. 

Occupational  Therapy. 

Dietitian. 

Dietitian's  Services. 

Dispensing  Optician. 

Optometrist. 

Optometric  Services. 

Hearing  Aid  Dispenser. 

Hearing  Aid. 

Speech  Pathologist. 

Speech  Pathology  Services. 

Audiologist. 

Audiological  Services. 

Sign  Language  Interpreter  Services. 

Psychologist. 

Psychologist  Services. 

Orthotist. 

Ocularist. 

Prosthetist. 

Durable  Medical  Equipment  and 

Medical  Supply  Providers. 

Incontinence  Medical  Supply 

Dealer. 

Pharmacist. 

Pharmacy. 

Pharmaceutical  Services. 

Inpatient. 

Hospital. 

Hospital  Acute  Care. 

Hospital  Extended  Care. 

Hospital  Long-Term  Care. 

Hospital  Extended  Care  Facility. 

Hospital  Intermediate  Care. 

Inpatient  Hospital  Services. 

Hospital  Outpatient  Department. 


§51113. 

Hospital  Outpatient  Department 

Services. 

§51115. 

Organized  Outpatient  Clinic. 

§51115.1. 

Organized  Outpatient  Clinic 

Services. 

§51115.5. 

Rural  Health  Clinic. 

§51115.6. 

Rural  Health  Clinic  Services. 

§51115.7. 

Rural  Shortage  Area. 

§51116. 

Outpatient  Heroin  Detoxification 

Services. 

§51117. 

Rehabilitation  Center. 

§51118. 

Intermediate  Care  Facility. 

§51119. 

Rehabilitation  Services. 

§51120. 

Intermediate  Care  Services. 

§51120.5. 

Nursing  Facility. 

§51121. 

Skilled  Nursing  Facility  Services. 

§51123. 

Skilled  Nursing  Facility  Services. 

§51124. 

Skilled  Nursing  Facility  Level  of 

Care. 

§51124.1. 

Transitional  Inpatient  Level  of  Care. 

§51124.2. 

Medi-Cal  Care  Coordinator. 

§51124.5. 

Subacute  Level  of  Care. 

§51124.6. 

Pediatric  Subacute  Care  Services. 

§51124.7. 

Preceptorship. 

§51125. 

Home  Health  Agency. 

§51127. 

Coordinated  Home  Care. 

§51128. 

Specialized  Rehabilitative  Services 

in  Skilled  Nursing  Facilities  or 

Intermediate  Care  Facilities. 

§51129. 

Home  Health  Agency  Services. 

§51131. 

Home  Nursing  Services. 

§51132. 

Short-Doyle  Medi-Cal  Providers. 

§51133. 

Home  Health  Aide  Services. 

§51134. 

Short-Doyle  Medi-Cal  Provider 

Services. 

§51135. 

Healing  by  Prayer  or  Spiritual 

Means. 

§51136. 

Christian  Science  Facility. 

§51137. 

Laboratory. 

§51137.1. 

Clinical  Laboratory  or  Laboratory. 

§51137.2. 

Clinical  Laboratory  or  Laboratory 

Services. 

§51139. 

Radiological  and  Radioisotope 

Services. 

§51141. 

Outpatient  Services. 

§51142. 

Inpatient  Services. 

§51143. 

Outpatient  Services. 

§51145. 

Home. 

§51145.1. 

"Home"  Defined  for  the  Personal 

Care  Services  Program. 

§51146. 

Homebound  Patient. 

§51147. 

Medical  Social  Work  or  Medical 

Social  Services. 

§51149. 

Social  Work  Services. 

§51151. 

Medical  Transportation  Services. 

§51151.1. 

Ambulance. 

§51151.2. 

Ambulance  Patient. 

§51151.3. 

Litter  Van. 

§51151.4. 

Litter  Van  Patient. 

§51151.5. 

Wheelchair  Van. 

§51151.6. 

Wheelchair  Van  Patient. 

§51151.7. 

Nonemergency  Medical 

Transportation. 

§51152. 

Provider  of  Medical  Transportation. 

§51153. 

Other  Medically  Indicated 

Transportation  Service. 

§51154. 

Renal  Dialysis  Center. 

§51155. 

Community  Hemodialysis  Unit. 

§51156. 

Renal  Homotransplantation  Center. 

§51157. 

Renal  Dialysis,  Renal 

Homotransplantation  and  Related 

Services. 

§51158. 

Nurse  Anesthetist. 

§51159. 

Utilization  Controls. 

§51159.1. 

Peer  Review. 

§51160. 

Durable  Medical  Equipment. 

§51161. 

Prosthetic  and  Orthotic  Appliances. 

Page 


Vlll 


(7-18-2008) 


Title  22 


Health  Care  Services 


Table  of  Contents 


Page 


Page 


§51162. 

Eyeglasses,  Prosthetic  Eyes,  and 

Other  Eye  Appliances. 

§51162.1. 

Fabricating  Optical  Laboratory. 

§51163. 

Human  Reproductive  Sterilization. 

§  51164. 

Intermediate  Care  Facility  for  the 

Developmentally  Disabled. 

§51164.1. 

Intermediate  Care  Facility  for  the 

Developmentally  Disabled 

Habilitative. 

§51164.2. 

Intermediate  Care  Facility  for  the 

Developmentally 

Disabled-Nursing. 

§51165. 

Intermediate  Care  Facility  Services 

for  the  Developmentally  Disabled. 

§51165.1. 

Intermediate  Care  Facility  Services 

for  the  Developmentally  Disabled 

Habilitative. 

§51165.2. 

Intermediate  Care  Facility  Services 

for  the  Developmentally 

Disabled — Nursing. 

§51170. 

Nonphysician  Medical  Practitioner. 

§51170.1. 

Physician's  Assistant. 

§51170.2. 

Nurse  Midwife. 

§51170.3. 

Nurse  Practitioner. 

§51170.5. 

Primaiy  Care. 

§51171. 

Physician-Practitioner  Interface. 

§51172. 

Date  of  Service. 

§51173. 

Acute  Administrative  Days. 

§51173.1. 

In-Home  Medical  Care  and  Nursing 

Facility  Waiver  Services. 

§51174. 

Paramedic  Ambulance  Services. 

§51175. 

Nurse  Midwife  Services. 

§51176. 

Home  and  Community-Based 

Waiver  Services. 

§51177. 

Swing  Bed  Services. 

§51178. 

Swing  Bed  Facility. 

§51179. 

Comprehensive  Perinatal  Services. 

§51179.1. 

Comprehensive  Perinatal  Provider. 

§51179.2. 

Comprehensive  Perinatal  Nutrition 

Services. 

§51179.3. 

Comprehensive  Perinatal 

Psychosocial  Services. 

§51179.4. 

Comprehensive  Perinatal  Health 

Education  Services. 

§51179.5. 

Personal  Supervision. 

§  51179.6. 

Case  Coordination. 

§51179.7. 

Comprehensive  Perinatal 

Practitioner. 

§51179.8. 

Individualized  Care  Plan. 

§51179.9. 

Protocol. 

§51179.10. 

Protocol. 

§51180. 

Hospice  Care. 

§51180.1. 

Hospice. 

§51180.2. 

Terminally  III. 

§51180.3. 

Routine  Home  Care. 

§51180.4. 

Continuous  Home  Care. 

§51180.5. 

Respite  Care. 

§51180.6. 

General  Inpatient  Care. 

§51180.7. 

Representative. 

§51181. 

Personal  Care  Services  Provider. 

§51182. 

Personal  Representative. 

§51183. 

Personal  Care  Services. 

§51184. 

Early  and  Periodic  Screening, 

Diagnosis,  and  Treatment  (EPSDT) 

Program  Definitions. 

§51185. 

Targeted  Case  Management 

Services  Program  Definitions. 

§51187. 

Tuberculosis  (TB)  Infection. 

§51187.1. 

Tuberculosis  (TB)  Related  Services. 

§51190.1. 

Local  Educational  Agency  (LEA) 

Eligible  Beneficiary. 

§51190.2. 

Local  Educational  Agency  (LEA) 

Provider. 

§51190.3. 

Local  Educational  Agency  (LEA) 

Practitioner. 

§51190.4. 

Local  Educational  Agency  (LEA) 

Services. 

§51190.5. 

Managed  Care  Plan. 

§5]]9]. 

Licensed  Midwife. 

§51192. 

Licensed  Midwife  Services. 

Article  3. 

Standards  for  Participation  424 

§51200. 

Basic  Requirement  for  Program 

Participation. 

§51200.01. 

Established  Place  of  Business. 

§51201. 

Physical  Therapy. 

§51201.1. 

Physical  Therapist. 

§  51202. 

Speech  Pathologist. 

§51202.5. 

Sign  Language  Interpreters. 

§51203. 

Occupational  Therapy. 

§51203.1. 

Occupational  Therapist. 

§  51204. 

Personal  Care  Services  Provider. 

§51205. 

Prosthetic  and  Orthotic  Appliance 

Facilities. 

§51206. 

Hospitals,  Home  Health  Agencies 

and  Laboratories. 

§51207. 

Hospitals. 

§51208. 

Dispensing  Optician. 

§51208.1. 

Fabricating  Optical  Laboratory. 

§51209. 

Hospital  Outpatient  Department. 

§51210. 

Blood  Banks. 

§51211. 

Other  Organized  Outpatient 

Services. 

§51211.1. 

Organized  Outpatient  Clinic. 

§51211.2. 

Laboratory  or  Clinical  Laboratory. 

§51211.5. 

Rural  Health  Clinic  Standards  for 

Participation. 

§51212. 

Intermediate  Care  Facility. 

§51213. 

Rehabilitation  Center. 

§51214. 

Hearing  Aid  Dispenser. 

§51215. 

Skilled  Nursing  Facilities. 

§51215.4. 

Transitional  Inpatient  Care  Unit. 

§  51215.5. 

Subacute  Care  Unit. 

§  51215.6. 

Participation  Requirements  for  the 

Adult  Subacute  Program  and 

Pediatric  Subacute  Program. 

§  51215.7. 

Application  for  Subacute  Care 

Contract. 

§51215.8. 

Pediatric  Subacute  Care  Unit. 

§  51215.9. 

Pediatric  Subacute  Care 

Unit — Physician  Services. 

§51215.10. 

Pediatric  Subacute  Care 

Unit — Rehabilitation  Therapy 

Services. 

§51215.11. 

Pediatric  Subacute  Care 

Unit — Ventilator  Weaning. 

§51216. 

Transfer  of  Ownership. 

§51217. 

Home  Health  Agency. 

§51218. 

Renal  Dialysis  Centers,  Corrmiunity 

Hemodialysis  Units  and  Renal 

Homotransplantation  Centers. 

§51219. 

Audiologist. 

§  51220. 

Chiropractor. 

§  51220.5. 

Acupuncturist. 

§51221. 

Christian  Science  Facilities. 

§  51222. 

Christian  Science  Practitioner. 

§51223. 

Dentist. 

§51224. 

Dental  School  Clinic. 

§  51224.5. 

Durable  Medical  Equipment  and 

Medical  Supply  Providers. 

§  51225. 

Orthotist. 

§  51225.5. 

Respiratory  Care  Practitioner. 

§51226. 

Pharmacy. 

§51227. 

Pharmacist. 

§  51228. 

Physician. 

§  51229. 

Podiatrist. 

§51230. 

Prosthetist. 

§51231. 

Ambulance  Requirements. 

§51231.1. 

Litter  Van  Requirements. 

§51231.2. 

Wheelchair  Van  Requirements. 

§  51232. 

Psychologist. 

§  51233. 

Optometrist. 

§  51234. 

Psychiatric  Technician. 

§51235. 

Dietitian. 

Page  ix 


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Title  22 


Page 


Page 


§  51236.  Radiological  and  Radioisotope 

Services. 
§  51237.  Nurse  Anesthetist. 

§  51238.  Short-Doyle  Medi-Cal  Provider. 

§  51239.  Outpatient  Heroin  Detoxification 

Provider. 
§  51240.  Utilization  of  Nonphysician  Medical 

Practitioners. 
§  51241.  Physician  Relationship  to 

Nonphysician  Medical 

Practitioners. 
§  51242.  EPSDT  Diagnosis  and  Treatment 

Provider  and  EPSDT  Supplemental 

Services  Provider. 
§  51242.1.  EPSDT  Supplemental  Services 

Provider — Pediatric  Day  Health 

Care  Facility. 
§  51243.  Intermediate  Care  Facility  for  the 

Developmentally  Disabled. 
§  5 1 243. 1 .  Intermediate  Care  Facility  for  the 

Developmentally  Disabled 

Habilitative. 
§  5 1243.2.  Intermediate  Care  Facility  for  the 

Developmentally 

Disabled-Nursing. 
§  51244.  In-Home  Medical  Care  Waiver 

Services  Provider  and  Nursing 

Facility  Waiver  Services  Provider. 
§51245.  Nurse  Midwife. 

§  51246.  Home  and  Cormnunity-Based 

Waiver  Services  Providers. 
§51247.  Swing  Bed  Facility. 

§51248.  Ocularist. 

§  51249.  Application  Process  for 

Comprehensive  Perinatal  Providers. 
§  51250.  Hospice. 

§51251.  Medical  Device  Retailer. 

§  51255.  Licensed  Midwife. 

§  51260.  Certified  Nurse  Practitioner. 

§  51270.  Local  Educational  Agency  (LEA) 

Provider. 
§51271.  Targeted  Case  Management 

Services  Provider  Qualifications. 
§  51272.  Targeted  Case  Manager. 

§51273.  Targeted  Case  Management 

Advisory  Committee. 
§  51276.  Directly  Observed  Therapy  (DOT) 

Provider  Qualifications. 

Article  4.  Scope  and  Duration  of 

Benefits  436.3 


§51301. 

Schedule  of  Benefits. 

§  51303. 

General  Provisions. 

§51304. 

Benefit  Liinitations. 

§  51305. 

Physician  Services. 

§51305.1. 

Criteria  for  the  Performance  of 

Sterilization. 

§  51305.2. 

Requirements  for  Sterilization  Other 

Than  Emergency  Sterilization. 

§  51305.3. 

Informed  Consent  Process  for 

Sterilization. 

§51305.4. 

Certification  of  Informed  Consent 

for  Sterilization. 

§  51305.5. 

Additional  Requirements  for 

Informed  Consent  Process  for 

Elective  Sterilization. 

§  51305.6. 

Hysterectomy. 

§51305.7. 

Noncompliance. 

§  51305.8. 

Effective  Date. 

§  51305.9. 

Interim  Coverage  of  Intermediate 

and  Comprehensive 

Ophthalmological  Services  for 

Nonaphakic  Beneficiaries. 

§  51306. 

Optometry  Services. 

§51306.1. 

Interim  Coverage  of  Optometric 

Services  for  Nonaphakic 

Beneficiaries  over  21. 

§  51307. 

Dental  Services.  [Repealed] 

§51308. 

Chiropractic  Services. 

§  51308.5. 

Acupuncture  Services. 

§51309. 

Psychology,  Physical  Therapy, 

Occupational  Therapy,  Speech 

Pathology  and  Audiological 

Services. 

§  51309.5. 

Sign  Language  Interpreter  Services. 

§51310. 

Podiatry  Services. 

§51311. 

Laboratory,  Radiological  and 

Radioisotope  Services. 

§51312. 

Prayer  or  Spiritual  Healing. 

§51313. 

Pharmaceutical  Services  and 

Prescribed  Drugs. 

§51313.3. 

Limitations  on  Coverage  of  Drugs 

on  the  Medi-Cal  List  of  Contract 

Drugs. 

§51313.6. 

Drug  Evaluafion  Criteria. 

§51314. 

Rehabilitation  Center  Outpatient 

Services. 

§51315. 

Prosthetic  and  Orthotic  Appliances. 

§51316. 

Respiratory  Care  Services. 

§51317. 

Eyeglasses,  Contact  Lenses,  Low 

Vision  Aids,  Prosthetic  Eyes  and 

Other  Eye  Appliances. 

§51317.1. 

Interim  Coverage  of  Eyeglass 

Lenses. 

§51319. 

Hearing  Aids. 

§  51320. 

Medical  Supplies. 

§51321. 

Durable  Medical  Equipment. 

§  51323. 

Medical  Transportation  Services. 

§51325. 

Blood  and  Blood  Derivatives. 

§  51326. 

Nurse  Anesthetist  Services. 

§51327. 

Inpatient  Hospital  Services. 

§  51328. 

Outpatient  Heroin  Detoxification 

Services. 

§  51329. 

Rehabilitation  Center  Services. 

§  51330. 

Chronic  Hemodialysis. 

§51330.1. 

Renal  Homotransplantation. 

§51331. 

Hospital  Outpatient  Department 

Services  and  Organized  Outpatient 

Clinic  Services. 

§51331.5. 

Rural  Health  Clinic  Services. 

§  51332. 

Organized  Outpatient  Clinic 

Services. 

§  51333. 

Other  Organized  Outpatient 

Services. 

§51334. 

Intermediate  Care  Services. 

§51335. 

Skilled  Nursing  Facility  Services. 

§  51335.1. 

Transitional  Inpatient  Care  Services. 

§51335.5. 

Subacute  Care  Services. 

§  51335.6. 

Pediatric  Subacute  Care  Services. 

§  51336. 

Specialized  Rehabilitative  Services 

in  Skilled  Nursing  Facilities  and 

Intermediate  Care  Facilities. 

§  51337. 

Home  Health  Agency  Services. 

§51338. 

Home  Health  Aide  Services. 

§51339. 

Special  Duty  Nursing. 

§  51340. 

Early  and  Periodic  Screening, 

Diagnosis,  and  Treatment  (EPSDT) 

Services  and  EPSDT  Supplemental 

Services. 

§51340.1. 

Requirements  Applicable  to  EPSDT 

Supplemental  Services. 

§51341. 

Short-Doyle  Mental  Health 

Medi-Cal  Program  Services. 

§51341.1. 

Drug  Medi-Cal  Substance  Abuse 

Services. 

§  51342. 

Acute  Administrative  Days. 

§  51343. 

Intermediate  Care  Facility  Services 

for  the  Developmentally  Disabled. 

Page 


(7-18-2008) 


Title  22 


Health  Care  Services 


Table  of  Contents 


Page 


Page 


§51343.1. 
§51343.2. 
§  51344. 


§  51345. 
§51345.1. 


§  51346. 


Intermediate  Care  Facility  Services 

for  the  Developmentally  Disabled 

Habilitative. 

Intermediate  Care  Facility  Services 

for  the  Developmentally 

Disabled-Nursing. 

In-Home  Medical  Care  Waiver 

Services  and  Nursing  Facility 

Waiver  Services. 

Nurse  Midwife  Services. 

Certified  Family  Nurse  Practitioner 

and  Certified  Pediatric  Nurse 

Practitioner  Services. 

Home  and  Community-Based 

Waiver  Services. 


§51347. 

Swing  Bed  Services. 

§  51348. 

Comprehensive  Perinatal  Services. 

§51348.1. 

Comprehensive  Perinatal  Standards 

of  Care. 

§51348.2. 

Patient  Rights. 

§  51349. 

Hospice  Care. 

§  51350. 

Personal  Care  Services. 

§51351. 

Targeted  Case  Management 

Services. 

§51351.1. 

Targeted  Case  Management 

Provider  Contracts. 

§  51355. 

Tuberculosis  (TB)  Related  Services. 

§  51356. 

Licensed  Midwife  Services. 

§  51360. 

Local  Educational  Agency  (LEA) 

Services. 

§  51365. 

Targeted  Case  Management 

Services  Program. 

Article  5. 

Scope  and  Duration  of 

Supplemental  Schedule  of 

Benefits  466.1 

§51401. 

Medically  Needy  Benefits. 

§  51403. 

General  Provisions. 

§  51405. 

Physicians'  Services. 

§  51406. 

Nursing  Home  and  Convalescent 

Home  Services. 

§  51407. 

Blood  and  Blood  Derivatives. 

§  51409. 

Physical  Therapy  Services. 

§51410. 

Podiatrists'  Services. 

§  51413. 

Prescribed  Drugs. 

§  51427. 

Inpatient  Hospital  Services. 

Article  6. 

Eligibility  for  Payment 466.1 

§51451. 

Inclusions,  Exclusions  and 

Suspensions. 

§  51452. 

Violation  of  Regulations, 

Administrative  Sanctions. 

§  51453. 

Recommendation  for  Suspension. 

§  51454. 

Provider  Defined. 

§  51454.1. 

Provider  of  Personal  Care  Services 

Defined. 

§  51455. 

Prior  Authorization. 

§  51456. 

Signing  Treatment  Authorization 

Requests. 

§  51457. 

Administrative  Action. 

§  51458. 

Cause  for  Suspension. 

§51458.1. 

Cause  for  Recovery  of  Provider 

Overpayments. 

§  51458.2. 

Statistical  Extrapolation  of 

Medi-Cal  Provider  Reviews. 

§  51459. 

Reinstatement. 

§  51460. 

Special  Claims  Review. 

§  51461. 

Orders  for  Suspension  or  Placement 

on  Prior  Authorization. 

§  51463. 

Requests  for  Hearing. 

§  51464. 

When  Hearing  Not  Requested. 

§  51465. 

Review  by  the  Director. 

§  51466. 

Disclosure  of  Significant  Beneficial 

Interest. 

^51466.1. 

Significant  Beneficial  Interest. 

§  51467. 

Advertising. 

§  51469. 

Decertificafion. 

§  51470.  Billing  for  Benefits  Provided. 

§  51471 .  Seeking  Reimbursement  from 

Beneficiaries. 
§  51471.1.  Reimbursements  for  Program 

Underpayments. 
§51472.  Sub-Standard  Services. 

§51473.  Excessive  Services. 

§  51473.1 .  Referral  for  Excessive  Services. 

§  5 1 473.2.  Services  to  Children. 

§51474.  False  Advertising. 

§  51475.  Refusal  to  Render  Services. 

§  51476.  Keeping  and  Availability  of 

Records. 
§  51476.1.  Pharmacy  and  Clinic  with  Special 

Permit  Records  of  Pharmaceutical 

Services. 
§  51476.2.  Personal  Care  Services  Records. 

§  51477.  Confidential  Beneficiary 

Information. 
§  51478.  Prohibition  of  Rebate,  Refund,  or 

Discount. 
§  51479.  Change  of  Order  or  Prescripfion. 

§  51480.  Discriminatory  Billings. 

§  5 1 48 1 .  Forbidden  Conduct. 

§  51482.  Unwarranted  Inpatient  Discharge. 

§51483.  Provider  Requirements. 

§  51483.1.  Personal  Care  Provider 

Requirements. 
§  51484.  Billing  for  Suspended  Provider. 

§  51485.  Submission  of  False  Information. 

§  51485.1 .  Civil  Money  Penalties. 

§  51486.  Medi-Cal  Card  Labels. 

§  51487.  Examinafions  of  Beneficiaries. 

§51488.  Pharmaceutical 

Postservice — Postpayment  On-Site 

Reviews  Including  Clinics  with 

Special  Permits. 
§  51488.1.  Pharmaceufical  Recovery  Standards 

Including  Clinics  with  Special 

Permits. 
§  51488.2.  Stadstical  Extrapolafion  for 

Medi-Cal  Pharmacy  Reviews. 
§  51488.3.  Underpayment  Adjustments  to 

Medi-Cal  Reviews  of  Pharmacies 

and  Clinics  with  Special  Permits. 
§51488.4.  Adjustments  to  Medi-Cal  Pharmacy 

and  Clinic  with  a  Special  Permit 

Reviews  for  Unsubmitted  Claims. 


§51489. 

Eligibility  for  Payment  for 

Paramedic  Ambulance  Services. 

§  51490. 

Claim  Submission  Requirements  for 

Short-Doyle  Medi-Cal  Providers. 

§51490.1. 

Claim  Submission  Requirements  for 

Counties  and  Providers  of  Drug 

Medi-Cal  Substance  Abuse 

Services. 

§  51491. 

Local  Educational  Agency  (LEA) 

Eligibility  for  Payment. 

§51492. 

Claim  Submission  Requirements  for 

Targeted  Case  Management 

Providers. 

§51492.1. 

Host  County  Contractual 

Responsibilifies  in  the  Targeted 

Case  Management  Program. 

§  51492.2. 

Participation  Fee  Requirements  in 

the  Targeted  Case  Management 

Program. 

Article  7. 

Payment  for  Services  and 

Supplies  471 

§51501. 

General. 

§  51502. 

Billing  Requirements. 

§51502.1. 

Requirements  for  Electronic  Claims 

Submission. 

§  51503. 

Physician  Services. 

Page  xi 


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Title  22 


Page 


Page 


§51503.1. 

Reimbursement  for  Services 

Rendered  by  a  Nonphysician 

Medical  Practitioner. 

§51503.2. 

Reimbursement  for  Services 

Rendered  by  a  Nurse  Midwife,  a 

Certified  Family  Nurse  Practitioner, 

or  a  Certified  Pediatric  Nurse 

Practitioner. 

§51503.3. 

Reimbursement  for  Sign  Language 

Interpreter  Services. 

§51504. 

Comprehensive  Perinatal  Services. 

§51504.1. 

Reimbursement  for  Services 

Rendered  by  a  Licensed  Midwife. 

§51505. 

Other  Professional  Services. 

§51505.1. 

Podiatry  Services. 

§51505.2. 

Nurse  Anesthetist  Services. 

§  51505.3. 

Psychology  Services. 

§  51506. 

Dental  Services. 

§51506.1. 

Maxillofacial  Dental  Services. 

§  51506.2. 

Orthodontic  Dental  Services. 

[Repealed] 

§51507. 

Physical  Therapy. 

§51507.1. 

Occupational  Therapy. 

§51507.2. 

Speech  Therapy  and  Audiology. 

§  51507.3. 

Respiratory  Care  Practitioner. 

§51508. 

Hospital  Inpatient  Services 

Reimbursement. 

§51508.1. 

Extraordinary  Administrative 

Adjustments. 

§51508.2. 

Definitions. 

§51508.3. 

Application. 

§51508.4. 

Review  of  Application. 

§  51508.5. 

Criteria  for  Review. 

§51508.6. 

Recommendation . 

§51508.7. 

Action  by  the  Director. 

§51508.8. 

Conditional  Administrative 

Adjustments. 

§51508.9. 

Medi-Cal  Hospital  Payment  Rate 

Exception. 

§  51509. 

Hospital  Outpatient  Departments. 

§51509.1. 

Organized  Outpatient  Clinics. 

§  51509.2. 

Chronic  Hemodialysis  Services. 

§51509.3. 

Rural  Health  Clinic 

Reimbursement. 

§51510. 

Nursing  Facility  Level  A  Services. 

§51510.1. 

Intermediate  Care  Services  for  the 

Developmentally  Disabled. 

§  51510.2. 

Intermediate  Care  Services  for  the 

Developmentally 

Disabled-Habilitative. 

§51510.3. 

Intermediate  Care  Services  for  the 

Developmentally 

Disabled-Nursing. 

§51511. 

Nursing  Facility  Level  B  Services. 

§51511.1. 

Special  Program  Services  for  the 

Mentally  Disordered. 

§51511.2. 

Uniform  Accounting  and  Cost 

Reporting  System  for  Skilled 

Nursing  Facilities  and  Intermediate 

Care  Facilities. 

§51511.3. 

Transitional  Inpatient  Care  Services 

Reimbursement. 

§51511.5. 

Nursing  Facility 

Services — Subacute  Care 

Reimbursement. 

§51511.6. 

Nursing  Facility  Services — Pediatric 

Subacute  Care  Reimbursement. 

§51512. 

Certified  Outpatient  Rehabilitation 

Centers. 

§51513. 

Pharmaceutical  Services  and 

Prescribed  Drugs. 

§51513.1. 

Average  Wholesale  Price  (AWP). 

§51513.2. 

Establishment  of  Maximum 

Allowable  Ingredient  Cost. 

§51513.3. 

Maximum  Allowable  Ingredient 

Cost. 

§51513.4. 

Maximum  Allowable  Cost. 

§51513.5. 

Estimated  Acquisition  Cost. 

§51513.6. 

Prudent  Purchase  of  Drugs 

Program. 

§51514. 

Chiropractic  Services. 

§51514.5. 

Acupuncture  Services. 

§51515. 

Reimbursement  for  Prosthetic  and 

Orthotic  Appliances  and  Repairs. 

§51516. 

Reimbursement  for 

Short-Doyle/Medi-Cal  Services. 

§51516.1. 

Reimbursement  Rates  for  Drug 

Medi-Cal  Substance  Abuse 

Program  Services. 

§51517. 

Hearing  Aids. 

§51518. 

Optometry  Services. 

§51519. 

Eye  Appliances. 

§51519.1. 

Dispensing  Fees  for  Ophthalmic 

Appliances  Supplied  by  a 

Fabricating  Optical  Laboratory 

Under  an  Exclusive  Area  Negotiated 

Contract, 

§51519.2. 

Reimbursement  Rates  for 

Ophthalmic  Appliances  Supplied  by 

a  Fabricating  Optical  Laboratory 

Under  an  Exclusive  Area  Negotiated 

Contract. 

§51520. 

Medical  Supplies. 

§51520.1. 

Establishment  of  Maximum 

Allowable  Product  Cost  for  Medical 

Supplies. 

§51520.2. 

List  of  Generic  Medical  Supply 

Types. 

§51521. 

Durable  Medical  Equipment. 

§51522. 

Hearing  and  Speech  Centers. 

§51523. 

Home  Health  Agency  Services. 

§  51524. 

in-Home  Medical  Care  Waiver 

Services  and  Nursing  Facility 

Waiver  Services. 

§51525. 

Blood  and  Blood  Derivatives. 

§  51526. 

Incontinence  Medical  Supplies. 

§51527. 

Medical  Transportation  Services. 

§51528. 

Paramedic  Ambulance  Services. 

§51529. 

Pathology  Services. 

§51531. 

X-Ray  Services. 

§51532. 

Early  and  Periodic  Screening, 

Diagnosis,  and  Treatment  (EPSDT) 

Services. 

§51532.1. 

Early  and  Periodic  Screening, 

Diagnosis  and  Treatment  (EPSDT) 

Supplemental  Services  Provided  by 

Registered  Nurses,  Licensed 

Vocational  Nurses  and  Certified 

Home  Health  Aides. 

§51532.2. 

Early  and  Periodic,  Screening, 

Diagnosis,  and  Treatment  (EPSDT) 

Supplemental  Services:  Onsite 

Investigation  to  Detect  the  Source  of 

Lead  Contamination. 

§51532.3. 

EPSDT  Supplemental  Services 

Provider — Pediatric  Day  Health 

Care  Facility  Reimbursement. 

§51533. 

Outpatient  Heroin  Detoxification 

Services. 

§51534. 

Home  and  Community-Based 

Services. 

§51535. 

Leave  of  Absence. 

§51535.1. 

Bed  Hold  for  Acute  Hospitalization. 

§51535.2. 

Reimbursement  Rates  for  Personal 

Care  Services  Program. 

§  51535.5. 

Local  Educational  Agency  (LEA) 

Services. 

§51535.6. 

Reimbursement  for  Directly 

Observed  Therapy  (DOT). 

§51535.7. 

Targeted  Case  Management 

Services  Reimbursement. 

Page 


XII 


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Title  22 


Health  Care  Services 


Table  of  Contents 


Page 

Page 

Article  7.5. 

Hospital  Inpatient  Services 

§53121. 

Medi-Cal  Beneficiary. 

Reimbursement  Section  516.4(d)(7) 

§  53122. 
§  53124. 

Member. 

Prepaid  Health  Plan. 

§51536. 

Hospital  Inpatient  Services 

§  53126. 

Prepaid  Patient  Population. 

Reimbursement. 

§  53128. 

Preventive  Health  Care. 

§  51537. 

Maximum  Allowable 

§  53130. 

Primary  Care  Physician. 

Reimbursement  Level  for  Inpatient 

§53132. 

Public  Hearing. 

Hospital  Services. 

§  53133. 

Risk  Limit. 

§  51538. 

Maximum  Allowable  Rate  of 

§  53134. 

Service  Area. 

Increase  for  Inpatient  Hospital 

§53136. 

Service  Location. 

Services. 

§53138. 

Service  Site. 

§51539. 

Hospital  Reimbursement  for 

§53140. 

State  Employee. 

Inpatient  Hospital  Services. 

§53142. 

State  Officer. 

§51540. 

Hospitals  with  a  Disproportionate 

§  53144. 

Subcontract. 

Share  of  Low  Income  Patients. 

§53144.5. 

Sub-Subcontract. 

§51541. 

Hospital  Inpatient  Services 

§  53145. 

Substantial  Financial  Interest. 

Reimbursement. 

§53150. 

Unit  Medical  Record. 

§51542. 

Acute  Administrative  Days. 

§53152. 

Vendor. 

§51543. 

Out-of-State  Hospital  Inpatient 

Services  Reimbursement. 

Article  3. 

Operational  Requirements 520 

§  51544. 

Hospice  Care. 

§  53200. 

Organization  and  Administration. 

§51545. 

Definitions. 

§  53210. 

Scope  of  Services. 

§  51546. 

Reimbursement  Limits. 

§  53212. 

Availability  of  Services. 

§51547. 

Methods  of  Payment. 

§  53214. 

Pharmaceutical  Services  and 

§  51548. 

Overpayments. 

Prescribed  Drugs. 

§51549. 

Reimbursement  Formula. 

§  53216. 

Care  Under  Emergency 

§51550. 

Administrative  Adjustment  Process. 

Circumstances. 

§51551. 

Specific  Administrative  Adjustment 

§  53218. 

Preventive  Health  Care  Services. 

Issues. 

§  53220. 

Member  Billing. 

§51552. 

AA  Formal  Appeals  Process. 

§  53222. 

Recovery  from  Other  Sources. 

§  51553. 

Peer  Grouping. 

§  53230. 

Facilities,  Service  Locations  and 

§  51554. 

Peer  Group  Administrative 

Equipment. 

Adjustments. 

§  53240. 

Personnel  Resources. 

§  51555. 

Peer  Group  Specific  Administrative 

§  53242. 

Providers. 

Adjustment  Issue. 

§  53244. 

Allied  Health  Personnel. 

§  51556. 

Contracts. 

§  53246. 

Medical  Director. 

§  51557. 

Disproportionate  Share. 

§  53250. 

Subcontracts. 

Article  8. 

Conflict  of  Interest 516.19 

§53251. 
§  53252. 

Assumption  of  Financial  Risk. 

Reinsurance. 

§51600. 

Definitions. 

§  53260. 

Grievance  Procedures. 

§51601. 

Exclusion  from  Proceedings. 

§53261. 

Notice  to  Meinbers  of  Plan  Action 

§  51602. 

Prohibition  Against  Contracting. 

to  Deny,  Defer  or  Modify  a  Request 

Article  10. 

Early  and  Periodic 

for  Medical  Services. 

§  53270. 

Consumer  Participation  in  Policy 

Screening,  Diagnosis,  and 

Making. 

Treatment  Program  517 

§  53280. 

Quality  of  Care. 

§  53282. 

Medical  Record  System. 

Chapter  3.5. 

Pilot  and  Demonstration 

§  53284. 
§  53286. 

Medical  Record  Service. 
Continuity  of  Care. 

Projects 517 

§  53288. 

Shared  Responsibility  for  Members' 
Health  Care. 

Chapter  4. 

Prepaid  Health  Plans 517 

§  53290. 

Medical  Review. 

§53291. 

General  Reviews. 

Article  1. 

General  Provisions 517 

§  53310. 
§  53312. 

Records. 

§  53000. 

General. 

Reporting. 

§  53314. 

Statistical  Data. 

Article  2. 

Definitions 517 

§  53320. 
§53321. 

Capitation  Payment. 
Capitation  Payment  Rates 

§53100. 

Acceptable  Medical  Care. 

§53101. 

Actuarial  Equivalence. 

Determination. 

§53101.1, 

Actuarial  Method. 

§  53322. 

Capitation  Rate  Redetermination. 

§53102. 

Affiliate. 

§  53323. 

Cost  Reimbursement. 

§53104. 

Carrier. 

§  53324. 

Financial  Resources. 

§  53106. 

Catastrophic  Coverage  Limitation. 

§  53326. 

Financial  Security. 

§  53108. 

Contract. 

§  53330. 

Affiliate. 

§53110. 

Control. 

§  53340. 

Financial  Audit. 

§53111. 

Department. 

§  53350. 

Civil  Penalties. 

§53112. 

Director. 

§  53352. 

Contract  Termination. 

§53114. 
§53115. 

Disenrollment. 
Door-to-Door  Marketing. 

Article  4. 

Marketing,  Enrollment  and 

§53115.5. 

Effective  Date  of  Enrollment. 

Disenrollment 528 

§53116. 

Enrollment. 

§  53400. 

Marketing. 

§53116.5. 

Experience  Data. 

§53401. 

Marketing  on  County  Premises. 

§53117. 

Facility. 

§53401.1. 

Marketing  on  State  Premises. 

§53117.3, 

Formal  Grievance. 

§  53402. 

Marketing  Representatives. 

§53117.7. 

Immediate  Family. 

§  53404. 

Marketing  Presentation. 

§53117.9. 

Informal  Grievance. 

§  53406. 

Misrepresentation. 

§53118. 

Marketing. 

§  53407. 

Door-to-Door  Marketing. 

§  53120. 

Marketing  Representative. 

§  53408. 

Prepaid  Patient  Population. 

Page  xiii 


(7-18-2008) 


Table  of  Contents 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


§  53420. 
§  53422. 
§  53424. 
§  53426. 
§  53440. 
§  53442. 
§  53450. 
§  53452. 
S  53454. 
§  53456. 
§  53458. 


Article  5. 


Page 

Member  Enrollment. 
Enrollment  Application. 
Enrollment  Application  Processing. 
Term  of  Membership. 
Disenrollmenl  of  Members. 
Discnrollment  Requests. 
Information  to  New  Enrollees. 
Information  to  New  Members. 
Annual  Information  to  Members. 
Notification  of  Changes  in  Services. 
Information  for  Departmental 
Dissemination. 

Applications,  Contracts  and 

Public  Hearings 530 


S  53500. 

Application  Information. 

S  53502. 

Rejection  of  Contract  Applications. 

§  53504. 

Effect  and  Term  of  Contracts. 

§  53506. 

Contract  Renewals. 

§  53508. 

Mergers  or  Reorganizations. 

^53510. 

Reorganizations  and  Intraplan 

Mergers. 

§53518. 

Prehearing  Requirements. 

§  53520. 

Public  Notice  and  Public  Healings. 

$  53522. 

Public  Hearing  Process. 

Article  6. 

Conflict  of  Interest 532 

§  53600. 

Prohibitions  Against  Contracting. 

§53601. 

Disclosure  Statements. 

Article  7. 

Emergency  Services  Claims 

Disputes  532 

§  53620. 

General  Provisions. 

§  53622. 

Definitions. 

§  53624. 

Claims  Filing. 

§  53626. 

Fihng  and  Service. 

§  53628. 

Claim  Content. 

§  53630. 

Dismissal  After  Notice  of  Defective 

Claim. 

§  53632. 

Notice  of  Defense. 

§  53634. 

Defaults. 

§  53636. 

Amended  or  Supplemental  Claims. 

§  53638. 

Consolidation  of  Claims. 

§  53640. 

Additional  Parties. 

§  53642. 

Withdrawal  or  Settlement  of  Claim. 

§  53644. 

Discovery. 

§  53646. 

Submissions. 

§  53648. 

Nondisclosure. 

§  53650. 

Expedited  or  Deferred  Proceedings. 

§  53651. 

Small  Claims  Procedure. 

§  53652. 

Request  for  Hearing. 

§  53654. 

Decision  on  Written  Record. 

§  53656. 

Prehearing  and  Posthearing 

Conferences. 

§  53658. 

Notice  of  Hearing. 

§  53660. 

Time  and  Place  of  Hearing. 

§  53662. 

Witnesses  and  Subpoenas. 

§  53664. 

Depositions. 

§  53666. 

Hearing  Officer. 

§  53668. 

Medical  Consultant. 

§  53670. 

Evidence  Rules. 

§  53672. 

Affidavits  As  Evidence. 

§  53674. 

Official  Notice. 

§  53676. 

Hearing  Procedure. 

§  53678. 

Record  of  Hearing. 

§  53680. 

Joint  Hearings. 

§  53682. 

Severance  of  Issues. 

§  53684. 

Oral  and  Written  Argument. 

§  53686. 

Confinued  Hearings. 

§  53688. 

Additional  Evidence. 

§  53690. 

Burden  of  Proof 

§53691. 

Decisions  by  the  Hearing  Officer. 

§  53692. 

Decision. 

§  53694. 

Reconsideration. 

§  53696. 

Relief  from  Decision  or  Order. 

§  53697. 

Judicial  Review. 

§  53698. 

Standard  of  Liability. 

Page 

§  53700.  Liquidation  of  Liability. 

§  53702.  Liability  Offset. 

Chapter  4. 1 .  Two-Plan  Model  Managed  Care 

Program 538 

Article  1.  General  Provisions 538 

§  53800.  General  Provisions. 

Article  2.  Definitions 538 

§53810.  Definitions. 

Article  3.  Maximum  Enrollment  Levels  ....  538.2 

§  53820.  Maximum  Enrollment  Levels. 

Article  4.  Prepaid  Health  Plan  and 

Primary  Care  Case 
Management  Plan  Enrollment 
Growth  During  the 

Transition  Period 538.2 

§  53830.  Prepaid  Health  Plan  and  Primary 

Care  Case  Management  Plan 
Enrollment  Growth  During  the 
Transition  Period. 

Article  5.  Two-Plan  Model 

Requirements 538.2(a) 

§  53840.  Two-Plan  Model  Requirements. 

§  53845.  Enrollment  Criteria. 

§  53850.  Organization  and  Administration. 

Article  6.  Operational  Requirements 538.2(c) 

§  53851.  Scope  of  Services. 

§  53852.  Availability  of  Services. 

§  53853.  Accessibility  of  Services. 

§  53854.  Pharmaceutical  Services  and 

Prescribed  Drugs. 
§  53855.  Care  Under  Emergency 

Circumstances. 
§  53856.  Facilities,  Service  Locafions,  and 

Equipment. 
§  53857.  Medical  Director. 

§  53858.  Member  Grievance  Procedures. 

§  53859.  Provider  Grievances  and 

Complaints. 
§53860.  Quality  of  Care. 

§53861.  Records. 

§  53862.  Reporting. 

§  53863.  Assumption  of  Financial  Risk. 

§  53864.  Financial  Standards/Resources. 

§  53865.  Financial  Performance  Guarantee. 

§  53866.  Member  Billing  and  Recovery  from 

Other  Sources. 
§  53867.  Subcontracts. 

§  53868.  Reinsurance. 

§  53869.  Capitation  Payment,  Payment  Rate 

Determination/Redetermination. 
§  53870.  Affiliated  Organizations  and 

Persons. 
§53871.  Financial  Audit. 

§  53872.  Civil  Penalties. 

§  53873.  Contract  Termination. 

§  53874.  Conflict  of  Interest. 

§  53875.  Emergency  Services  Claims 

Disputes. 
§  53876.  Cultural  and  Linguistic 

Requirements. 

Article  7.  Marketing,  Enrollment, 

Assignment,  and 

DisenroUment 538.2(j) 

§  53880.  Marketing. 

§  53881 .  Marketing  and  Member  Materials. 

§  53882.  Member  Enrollment. 

§53883.  Assignment  of  Eligible 

Beneficiaries  to  Plans. 
§  53884.  Assignment  System. 


Page  xiv 


(7-18-2008) 


Title  22 


Health  Care  Services 


Table  of  Contents 


Page 


Page 


§  53885. 
§  53886. 
§  53887. 
§  53888. 
§  53889. 

§  53890. 

§  53890.5. 

§  53891. 
§  53892. 

§  53893. 

§  53894. 


§  53895. 
§  53896. 
§  53897. 
§  53898. 


Travel  Distance  Standards. 

Health  Care  Options  Presentation. 

Exemption  from  Plan  Enrollment. 

Enrollment/DisenroUment  Form. 

Enrollment/Disenrollment 

Processing. 

Assignment  of  Primary  Care 

Physician. 

Assignment  of  a  Primary  Care 

Provider. 

Disenrollment  of  Members. 

Problem  Resolution  Process  for 

Members. 

Medi-Cal  Managed  Care 

Ombudsman. 

Notice  to  Members  of  Plan  Action 

to  Deny,  Defer  or  Modify  a  Request 

for  Medical  Services. 

Information  to  New  Members. 

Annual  Information  to  Members. 

Notification  of  Changes  in  Services. 

Information  for  Departmental 

Dissemination. 


§  53927.5.  Notification  of  Changes  in  Services. 

§  53928.  Information  for  Departmental 

Dissemination. 


Chapter  5. 


Adult  Day  Health  Care 538.10 


Chapter  4.5.          Geographic  Managed  Care 
Program  


Article  1. 

§  53900. 
§  53902. 
§  53904. 
§  53906. 

Article  2. 

§  53910. 
§  53910.5. 
§53911. 
§53911.5. 

§  53912. 

§  53912.5. 

§  53913. 

§53913.5. 

§  53914. 
§  53914.5. 

§  53915. 
§  53915.5. 
§  53916. 

Article  3. 


§  53920. 
§  53920.5. 
§  53921. 
§53921.5. 

§  53922. 
§  53922.5. 
§  53923. 
§  53923.5. 

§  53924. 
§  53924.5. 

§  53925. 

§  53925.5. 
§  53926. 

§  53926.5. 
§  53927. 


538.2(r) 

General  Provisions 538.2(r) 

General. 

Definitions. 

CMC  Plan  Requirements. 

Eligible  Beneficiaries. 

Operational  Requirements 538.3 

Organization  and  Administration. 

Scope  of  Services. 

Availability  of  Services. 

Accessibility  to  Physicians  and 

Dentists. 

Pharmaceutical  Services  and 

Prescribed  Drugs. 

Care  Under  Emergency 

Circumstances. 

Facilities,  Service  Locations  and 

Equipment. 

Medical  Director  and  Dental 

Director. 

Member  Grievance  Procedures. 

Provider  Grievances  and 

Complaints. 

Quality  of  Care. 

Records. 

Reporting. 

Marketing,  Enrollment, 

Assignment,  and 

Disenrollment 538.6 


Marketing. 

Marketing  and  Member  Materials. 

Member  Enrollment. 

Assignment  of  Eligible 

Beneficiaries  to  GMC  Plans. 

Equitable  Distribution. 

Travel  Distance  Standards. 

Options  Presentation. 

Alternative  to  GMC  Plan 

Enrollment. 

Enrollment/Disenrollment  Form. 

Enrollment/Disenrollment  Form 

Processing. 

Assignment  of  Primary  Care 

Provider. 

Disenrollment  of  Members. 

Problem  Resolution  Process  for 

Members. 

Information  to  New  Members. 

Annual  Information  to  Members. 


Article  I. 

General  Provisions 538.10 

§54001. 

General. 

§  54003. 

Definitions  and  Standards. 

§  54005. 

Grants. 

Article  2. 

Definitions 538.10 

§54101. 

Activity  Program. 

§  54103. 

Adult  Day  Health  Care. 

§54105. 

Adult  Day  Health  Center. 

§  54107. 

Adult  Day  Health  Care  County 

Plan. 

§  54108. 

Adult  Day  Health  Caie  Planning 

Council. 

§  54109. 

Affiliate. 

§54111. 

Beneficiary  Agreement  of 

Participation. 

§54113. 

Day  of  Attendance. 

§54115. 

Daily  Rate. 

§54117. 

Discharge. 

§54119. 

Individualized  Plan  of  Care. 

§54121. 

MuUidisciplinary  Team. 

§54123. 

Nonmedical  Transportation. 

§  54125. 

Nutrition  Service. 

§  54127. 

Nursing  Service. 

§  54129. 

Occupational  Therapy. 

§54131. 

Participant. 

§54133. 

Psychiatric  and  Psychological 

Services. 

§54135. 

Service  Area. 

§  54137. 

Staff  Physician  Services. 

§  54139. 

Subcontract. 

§54141. 

Supervision. 

Article  3. 

Eligibility,  Participation 

and  Discharge 539 

§54201. 

Eligibility. 

§  54203. 

Participation. 

§  54205. 

Physician  Request. 

§  54207. 

MuUidisciplinary  Team  Assessment. 

§  54209. 

Prior  Authorization. 

§54211. 

MuUidisciplinary  Team. 

§54213. 

Discharge. 

§  54215. 

Reassessment. 

§  54217. 

Beneficiary  Agreement  of 

Participation. 

§54221. 

Hours  of  Operation. 

§  54223. 

Attendance. 

Article  4. 

Services  and  Standards 541 

§54301. 

Certification. 

§  54303. 

Denial  of  Initial  Certification. 

§  54305. 

Termination  or  Suspension  of 

Certification. 

§  54307. 

Denial  of  Renewal  of  Certification. 

§  54309. 

Required  Services. 

§54311. 

Optional  Services. 

§  54313. 

Physical  Therapy  Service. 

§  54315. 

Occupational  Therapy  Services. 

§  54317. 

Speech  Therapy  Services. 

§  54319. 

Staff  Physician  Services. 

§54321. 

Personal  Physician. 

§  54323. 

Nursing  Service. 

§  54325. 

Psychiatric  and  Psychological 

Services. 

§  54327. 

Personal  Psychiatrist  and 

Psychologist  Services. 

§  54329. 

Medical  Social  Services. 

§54331. 

Nutrition  Service. 

§  54333. 

Transportation. 

§  54335. 

Emergency  Service. 

§  54337. 

Program  Aides. 

§  54339. 

Activity  Program. 

Page  XV 


(7-18-2008) 


Table  of  Contents 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


Page 


Page 


Article  5. 

Administration 

§54401. 

Organization  and  Administration. 

§  54403. 

Administrator. 

§  54405. 

Program  Director. 

§  54406. 

Activity  Coordinator. 

§  54407. 

Grievance  Procedure. 

§  54409. 

Participant  Fair  Hearing. 

§54411. 

Reports. 

§54413. 

Financial  Reporting. 

§  54415, 

Medical  Review. 

§54417. 

On-Site  Visits. 

§54419. 

Utilization  Review  Conunittee. 

§54421. 

Advisory  Comniittees. 

§  54423. 

Staffing  Requirements. 

§  54425. 

Participant  Records. 

§  54429. 

Solicitation. 

§54431. 

Service  Aiea. 

§  54433. 

Subcontracts. 

§  54435. 

Civil  Rights  of  Participants. 

§  54437. 

Civil  Rights  of  Employees. 

§  54439. 

Confidentiality  of  Data. 

§  54443. 

Informational  Material. 

§  54445. 

Conflict  of  Interest. 

§  54447. 

Provider  Sanctions. 

Article  6. 

Payment  of  Services  

§54501. 

Adult  Day  Health  Care  Services. 

§  54503. 

Fee  Schedule. 

§  54504. 

Transition  Visits. 

§  54505. 

Initial  Assessment  Rate. 

§  54507. 

Billing  Requirements. 

546 


551 


Chapter  5.5.         Indians  and  Indian  Health 

Service  Facilities  in  Medi-Cal 

Managed  Care  Programs 552 

§  55000.  General. 

§55100.  Definitions. 

§  55110.  Enrollment  of  Indians  in  Medi-Cal 

Managed  Care  Plans. 
§  55120.  Indian  Health  Service  Facility 

Participation  in  Medi-Cal  Managed 

Care  Programs. 
§  55130.  Indian  Health  Service  Facilities  as 

Fee-for-Service  Managed  Care 

Plans. 
§  55140.  Indian  Health  Service  Facility 

Reimbursement  When 

Subcontracting  with  a  Medi-Cal 

Managed  Care  Plan. 
§  55150.  Indian  Health  Service  Facility 

Out-of-Plan  Reimbursement. 
§  55160.  Indian  Health  Service  Facility 

Fee-for-Service  Managed  Care  Plan 

Reimbursement. 
§  55170.  Indian  Health  Service  Facilities  and 

Non-Indian  Beneficiaries. 
§  55180.  Indian  Health  Service  FaciUties  and 

the  Health  Care  Options  Program. 

Chapter  6.  Primary  Care  Case  Management 

Plans  552.3 

Article  1.  General  Provisions 552.3 

§  56000.  General. 

Article  2.  Definitions 552.4 

§  56100.  Acceptable  Medical  Care. 

§  56101.  Actuarial  Equivalence. 

§  56101.1.  Actuarial  Method. 

§  56102.  Affiliate. 

§  56114.  Disenrollment. 

§  561 1 5.  Door-to-Door  Marketing. 

§  56115.5.  Effective  Date  of  Enrollment. 

§56116.  Enrollment. 

§  56116.5.  Experience  Data. 

§56117.  Facility. 


§56118. 

Marketing. 

§56120, 

Marketing  Representative. 

§56122. 

Member. 

§56124. 

Optional  Services. 

§56130. 

PCCM  Contract. 

§56133, 

Risk  Limit. 

§56138, 

Service  Site. 

§56144. 

Subcontract. 

§56144.5. 

Sub-Subcontract. 

§56146. 

Written  Approval. 

§  561 52. 

Vendor. 

Article  3. 

Operational  Requirements 556 

§  56200. 

Organization  and  Administration. 

§56210. 

Scope  of  Services. 

§56212. 

Availability  of  Services. 

§56214. 

Pharmaceutical  Services  and 

Prescribed  Drugs. 

§56216. 

Care  Under  Emergency 

Circumstances. 

§  56220. 

Member  Billing. 

§  56222. 

Recovery  from  Other  Sources. 

§  56230. 

Facilities  and  Service  Sites. 

§  56242. 

Providers. 

§  56246. 

Medical  Director. 

§  56250. 

Subcontracts. 

§56251. 

Assumption  of  Financial  Risk. 

§  56252. 

Reinsurance. 

§  56260. 

Grievance  Procedures. 

§56261. 

Notice  to  Members  of  PCCM  Plan 

Action  to  Deny,  Defer  or  Modify  a 

Request  for  Medical  Services. 

§  56262. 

Provider  Grievance  and  Complaints. 

§  56264. 

Member  Complaints. 

§  56280. 

Quality  of  Care. 

§  56284. 

ConfidentiaUty  of  Medical  Records. 

§  56286. 

Continuity  of  Care. 

§56310. 

Records. 

§  56312. 

Reporting. 

§  56314. 

Statistical  Data. 

§  56320. 

Capitation  Payment. 

§56321. 

Capitation  Payment  Rates 

Determination. 

§  56322. 

Capitation  Rate  Redetermination. 

§56322.1. 

Savings  Sharing. 

§  56324. 

Financial  Resources. 

§  56326. 

Financial  Security. 

§  56330. 

Affiliate. 

§  56340. 

Financial  Audit. 

§  56350. 

Civil  Penalties  and  Sanctions. 

§  56352. 

Contract  Termination. 

Article  4. 

Marketing,  Enrollment  and 

Disenrollment 565 

§  56400. 

Markefing. 

§56401. 

Door-to-Door  Marketing. 

§  56402. 

Marketing  Representative. 

§  56404. 

Markefing  Presentation. 

§  56406. 

Misrepresentation. 

§  56408. 

Penalties  for  Misrepresentation. 

§  56420. 

Member  Enrollment. 

§  56424. 

Designation  Form  Processing. 

§  56426. 

Term  of  Membership. 

§  56440. 

Disenrollment  of  Members. 

§  56442. 

Disenrollment  Requests. 

§  56450. 

Informafion  to  Prospecfive 

Members. 

§  56452. 

Information  to  New  Members. 

§  56456. 

Nofificafion  of  Changes  in  Services. 

Article  5. 

Application  and  Proposal 568.1 

§  56500. 

Application  and  Proposal 

Information. 

§  56502. 

PCCM  Contract  Selection  Criteria. 

§  56505. 

Contract  Term. 

§  56506. 

Contract  Renewals. 

§  56508. 

Mergers,  Reorganizations  or 

Assumpfions. 

Page 


XVI 


(7-18-2008) 


Title  22 


Health  Care  Services 


Table  of  Contents 


§  56520. 

Article  6. 

§  56600. 


Public  Notice. 

Conflict  of  Interest  . . 
Conflict  of  Interest. 


Chapter  7. 


Article  1. 

§  57000. 
S  57003. 
§  57006. 
§  57009. 
§  57012. 
§  57015. 
§57018. 
§57021. 
§  57024. 

Article  2. 


§  57027. 
§  57030. 

Article  3. 


§  57033. 

§  57036. 
§  57039. 


Construction/Renovation 
Reimbursement  Program 


Definitions 

Capital  Expenditure  Project. 

Debt  Service. 

Disproportionate  Share  Hospital. 

Final  Plans. 

Fixed  Equipment. 

New  Debt. 

Revenue  Bond. 

Three  Most  Recent  Years. 

Supplemental  Reimbursement. 

Eligibility  for  Construction/ 
Renovation  Reimbursement 
Program  

Hospital  Eligibility. 
Capital  Expenditure  Project 
Certification. 
f 

Standards  for  Supplemental 
Reimbursement 


Page 

568.3 

568.4 
568.4 


Page 


§  58030.  Qualified  Official  Designee  of  a 

Care  Management  Provider  Agency. 


570 


§58031. 

Quarterly/Annually. 

§  58032. 

Residential  Care  Facility. 

§  58033. 

Respite  Care. 

§  58034. 

Service  Summary. 

§  58035. 

Severe  Cognitive  Impairment. 

§  58036. 

Shortened  Benefit  Period 

Nonforfeiture  Benefit. 

§  58037. 

Standby  Assistance. 

§  58038. 

Substanfial  Supervision. 

Article  2. 

Conditions  of  Issuer 

Participation  578 

§  58050. 

Issuer  Requirements. 

§58051. 

Targefing  Requirements. 

§  58052. 

Marketing  and  Disclosure 

Requirements. 

§  58053. 

Conversion  of  Policies  or 

Certificates. 

§  58054. 

Conversion  of  Certified  Policies  and 

Certificates  to  Non-Certified  Status. 

§  58055. 

Issuer's  Liability. 

§  58056. 

Agent  Training. 

§  58057. 

Termination  of  Issuer  Participation. 

§  58058. 

Conditions  Governing 

Discontinuance  of  Sales  by  the 

Issuer. 

570 


Article  3. 


Chapter  8. 


Supplemental  Reimbursement 
Calculation. 

Reimbursement  Provisions. 
Continuing  Eligibility. 

California  Partnership  for  Long- 
Term  Care 


Benefits  and  Provisions  for 
Partnership  Policies  and 
Certificates  


icle  1. 

Definitions 

§  58000. 

Activities  of  Daily  Living. 

§58001. 

Adult  Day  Health/Social  Care. 

§  58002. 

Average  Daily  Private  Pay  Rate  for 

Nursing  Facilities. 

§  58003. 

Benefit  Eligibility. 

§  58004. 

California  Partnership  for 

Long-Term  Care. 

§  58005. 

Care  Management/Care 

Coordination. 

§  58006. 

Care  Management  Provider  Agency. 

§  58007. 

Care  Management  Supervisor. 

§  58008. 

Care  Manager/Coordinator. 

§  58009. 

Certificate. 

§  58010. 

Elimination  Period. 

§58011. 

Formal  Long-Term  Care  Services. 

§  58012. 

Hands-On  Assistance. 

§  58013. 

Home  Health  Care  Services. 

§  58014. 

Elimination  Period. 

§  58015. 

Formal  Long-Term  Care  Services. 

§  58016. 

Home  Health  Care  Services. 

§  58017. 

Homemaker  Services. 

§58018. 

Hospice  Services. 

§  58019. 

Informal  Long-Term  Care  Services. 

§  58020. 

Issuer. 

§58021. 

Licensed  Health  Care  Practitioner. 

§  58022. 

Long-Term  Care  Services 

Countable  Toward  Medi-Cal 

Property  Exemption. 

§  58023. 

Medi-Cal  Asset  Protection. 

§  58024. 

Medi-Cal  Property  Exemption. 

§  58025. 

Partnership  Long-Term  Care 

Insurance  Policy  or  Certificate,  or 

Partnership  Policy  or  Certificate. 

§  58026. 

Personal  Care  Services. 

§  58027. 

Plan  of  Care. 

§  58028. 

Policy. 

§  58029. 

Qualified  Long-Term  Care 

Services. 

571 


§  58059. 
§  58060. 
§58061. 

§  58062. 


Required  Benefits  for  Partnership 
Policies  and  Certificates. 
Required  Provisions  for  Partnership 
Policies  and  Certificates. 
Required  Provisions  to  Allow  the 
Increase  or  Decrease  of  Benefits  in 
Partnership  Policies  or  Certificates. 
Benefits  and  Provisions  Allowable 
in  Partnership  Policies  or 
Certificates. 


584 


§  58063. 

Prohibited  Provisions  in  Partnership 

Policies  or  Certificates. 

§  58064. 

Information  for  Establishing 

Allowable  Benefits  and  Minimum 

and  Maximum  Benefits. 

Article  4. 

Premium  Provisions 589 

§  58065. 

Basic  Premium  Provisions. 

§  58066. 

Provisions  Governing  Premiums 

When  Benefits  Increase  or 

Decrease. 

§  58067. 

Provisions  Governing  Rate 

Increases. 

Article  5. 

Care  Management  Provider 

Agency  Standards 590 

§  58068. 

Care  Management  Provider  Agency 

Funcdons. 

§  58069. 

The  Role  of  the  Care  Management 

Supervisor. 

§  58070. 

Staff  Qualificafions. 

§  58071. 

Staff  Ratios. 

§  58072. 

Client  Bill  of  Rights  and 

Responsibilities. 

§  58073. 

Quality  Assurance. 

§  58074. 

Annual  Report  of  the  Agency's 

Quality  Assurance  Program. 

§  58075. 

Objectivity  and  Impartiality. 

§  58076. 

Policy  Manual. 

Article  6. 


§  58077. 


Issuer  Reporting 
Requirements  and  Audit 

Information 

Issuer  Reporting  Requirements. 


592 


Page  xvii 


(7-18-2008) 


Table  of  Contents 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


Page 


Page 


§  58078. 

Records  Maintenance. 

§  58079. 

Reporting  to  tiie  Policy  or 

Certificate  Holder  on  the  Medi-Cal 

Property  Exemption. 

§  58080. 

Preparing  a  Service  Summary. 

§58081. 

Plan  of  Action  for  Information  and 

Document  Maintenance. 

§  58082. 

Auditing  and  Correcting 

Deficiencies  in  Issuer  Record 

Keeping. 

Chapter  11. 


Article  1. 


§  59998. 
§  59999. 


Drug  Formulary  and  Medical 

Supplies  Listing  596 

Medical  Supplies  and  Medi- 
Cal  Drug  Formulary   596 

Medical  Supplies. 

Medi-Cal  Drug  Formulary. 


Page  xviii 


(7-18-2008) 


Title  22 


Health  Care  Services 


§  50009 


Division  3.     Health  Care  Services 


Subdivision  1.     California  Medical 
Assistance  Program* 

(Originally  Filed  2-28-66) 

Note:  Authority  cited  for  Subdivision  1:  Sections  14100, 141 05  and  14106,  Wel- 
fare and  Institutions  Code.  Additional  authority  cited  for  regulations  filed  on 
9-30-71:  Sections  14005.6,  14106.5,  14122,  14124.5,  14134,  W.  &  1.  Code,  and 
Sec.  53.6  of  Chapter  577,  Stats,  of  1971.  Additional  authority  cited:  Section 
14124.5,  Welfare  and  Institutions  Code.  Additional  authority  cited  for  regulation 
filed  1-18-74:  Sections  10541,  10553.1.  10554,  10554.1,  11004,  1 1050,  1 1100, 
14000,  14005.1, 14005.2,  14005.4,  14005.7,  14008, 14016, 14017, 14023, 14051, 
14053,  14053.6,  14060,  14061,  14100.1,  14132,  14184  and  14329.  Welfare  and 
Insfitutions  Code.  Reference:  Sections  11004,  11050,  11100.  14000,  14005.1, 
14005.2, 14005.4, 14005.6, 14005.7, 14008, 14016, 14017, 14023, 14051,  14053, 
14053.6, 14059,  14100.1, 14132, 14133, 14184,  14256, 14261,  14301  and  14329, 
Welfare  and  Institutions  Code. 

Chapter  1.     introduction 

§  50000.    Meaning  of  Words. 

Words  shall  have  their  usual  meaning  unless  the  context  or  a  definition 
clearly  indicates  a  different  meaning.  Shall  means  mandatory.  May 
means  permissive.  Should  means  suggested  or  recommended. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14124.5,  Welfare  and  Institutions  Code. 

History 

1 .  Repealer  of  Chapter  1  (Sections  50001-5001 1 ,  not  consecutive)  and  new  Chap- 
ter 1  (Sections  50000-50009,  50009.1-50009.3)  filed  12-20-76  as  an  emer- 
gency; designated  effective  1-1-77.  Certificate  of  Compliance  included  (Reg- 
ister 76,  No.  52).  For  history  of  former  Chapter  1,  see  Registers  66,  Nos.  6  and 
36;  67,  Nos.  8, 15  and  23;  68,  No.  43;  71,  No.  40;  72,  No.  5;  73,  No.  26;  74,  No. 
3.  For  history  of  Subdivision  1,  see  Register  66,  No.  6. 

2.  Amendment  filed  6-22-87;  operative  7-22-87  (Register  87,  No.  27). 

§  50001 .    Department. 

NOTE:  Authority  cited:  Sections  10554.1  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  17.1,  10000,  10002,  10020,  10021,  10022,  10023, 
10024,  10025,  10052,  10058,  10554.1,  10555,  10600,  10608,  10800,  10800.1, 
10803, 10806, 10809,  10850, 10851, 10852, 10853, 10900, 10950, 10951, 10952, 
10953, 10954, 10956, 10957, 10958, 10959, 10960,  10961, 10962, 10963,  10964, 
10965,  11000, 11002, 1 1003, 1 1004, 11005.5, 1 1008, 11008.2, 11008.6, 11008.7, 
11008.9,  11008.10,  11018,  11050,  11051,  110.52,  11053,  11054,  11055,  11057, 
11100.  11102,  11150,  11151,  11152,  11153.7,  11155,  11157,  11158,  11205, 
11257,  11452,  12150,  12152,  12305,  13000,  14000,  14000.2,  14001,  14002, 
14003.  14005,  14005.1,  14005.4,  14005.7,  14005.8,  14005.9,  14005.12, 
14005.13,  14006,  14007,  14008,  14008.5,  14009,  14011,  14012.  14013,  14014, 
14015,  14016,  14017,  14018,  14019,  14023,  14026.  14050.1,  14050.2,  14050.3, 
14051,  14052,  14053,  14054,  14057,  14061,  14062,  14063,  14100.1,  14103.6, 
14104.3,  14109,  14112,  14115,  14119,  14122,  14124.5,  14133,  14140,  14141, 
14142, 14143, 14144, 14201  and  14252,  Welfare  and  Insfitutions  Code  and  Chap- 
ter 2,  Part  1,  Division  1,  Article  3.1,  Section  306  et  seq..  Health  and  Safety  Code, 
and  to  implement,  interpret  or  make  specific  Chapter  1252,  Statutes  of  1977  (SB 
363),  SB  1410  (1978)  and  SB  1596  (1978). 

History 

1.  Amendment  filed  6-30-78  as  an  emergency;  designated  effecfive  at  1 1 :59  p.m. 
on  6-30-78  (Register  78,  No.  26). 

2.  Certificate  of  Compliance  transmitted  to  OAH  1 0-27-78;  filed  1 0-31-78  (Reg- 
ister 78,  No.  44). 

3.  Repealer  filed  6-22-87;  operative  7-22-87  (Register  87,  No.  27). 

§  50002.    Director. 

NOTE:  Authority  cited:  Sections  10554.1  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Secfions  17.1,  10000,  10002,  10020.  10021,  10022,  10023, 
10024,  10025,  10052,  10058,  10554.1,  10555,  10600,  10608,  10800,  10800.1, 
10803, 10806, 10809,  10850, 10851, 10852, 10853, 10900,  10950, 10951, 10952, 
10953, 10954, 10956, 10957, 10958, 10959, 10960, 10961, 10962, 10963, 10964, 
10965, 1 1000, 1 1002, 1 1003, 1 1004, 1 1005.5, 1 1008, 1 1008.2, 1 1008.6. 1 1008.7. 
11008.9,  11008.10,  11018,  11050,  11051,  11052,  11053,  11054,  11055,  11057, 
11100,  11102,  11150,  11151,  11152,  11153.7,  11155,  11157,  11158,  11205, 
11257,  11452,  12150,  12152,  12305,  13000,  14000,  14000.2,  14001,  14002, 
14003,  14005,  14005.1,  14005.4,  14005.7,  14005.8,  14005.9.  14005.12, 
14005.13,  14006,  14007,  14008,  14008.5,  14009,  14011,  14012,  14013,  14014, 
14015,  14016,  14017,  14018,  14019,  14023,  14026,  14050.1,  14050.2,  14050.3, 
14051,  14052,  14053,  14054,  14057,  14061,  14062,  14063,  14100.1,  14103.6, 


14104.3,  14109,  14112,  14115.  14119,  14122,  14124.5,  14133,  14140,  14141, 
14142, 14143, 14144,  14201  and  14252,  Wei  fare  and  Institutions  Code  and  Chap- 
ter 2,  Pan  1.  Division  1,  Article  3.1,  Section  306  et  seq..  Health  and  Safety  Code, 
and  to  implement,  interpret  or  make  specific  Chapter  1252,  Statutes  of  1977  (SB 
363),  SB  1410  (1978)  and  SB  1596(1978). 

History 

1 .  Amendment  filed  6-30-78  as  an  emergency;  designated  effective  at  1 1 :59  p.m. 
on  6-30-78  (Register  78,  No.  26). 

2.  Certificate  of  Compliance  transmitted  to  OAH  10-27-78;  filed  10-31-78  (Reg- 
ister 78,  No.  44). 

3.  Repealer  filed  6-22-87;  operative  7-22-87  (Register  87,  No.  27). 

§  50003.    Medi-Cal  Program. 

History 

1.  Repealer  filed  6-22-87;  operative  7-22-87  (Register  87,  No.  27). 

§  50004.    Medi-Cal  Program  Administration. 

(a)  The  Department  is  the  single  state  agency  approved  by  the  Secre- 
tary of  the  Department  of  Health  and  Human  Services  to  administer  the 
Medi-Cal  program. 

(b)  The  Department  shall  administer  the  Medi-Cal  program  in  accor- 
dance with  the  following: 

(1)  The  State  Plan  under  Title  XTX  of  the  Social  Security  Act. 

(2)  Applicable  State  law,  as  specified  in  the  Welfare  and  Institutions 
Code. 

(3)  Medi-Cal  regulations. 

(c)  The  county  welfare  department  in  each  county  shall  be  the  agency 
responsible  for  local  administration  of  the  Medi-Cal  program  under  the 
direction  of  the  Department. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Insfitufions 
Code.  Reference:  Sections  10722, 10743, 1 1050, 14001 .1  and  14100,  Welfare  and 
Institutions  Code. 

History 

1.  Amendment  filed  6-22-87;  operative  7-22-87  (Register  87,  No.  27). 

§  50005.    Medi-Cal  Regulations. 

Regulations  promulgated  by  the  Department  for  purposes  of  adminis- 
tering the  Medi-Cal  program  shall  be  known  as  Medi-Cal  regulations. 
These  regulations  comprise  Division  3,  Title  22,  California  Administra- 
tive Code. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Insfitutions 
Code.  Reference:  Sections  10060, 10743, 14002  and  14124.5,  Welfare  and  Institu- 
tions Code. 

History 

1.  Change  without  regulatory  effect  adding  NOTE  (Register  86,  No.  49). 

§  50006.    Conformity  with  Federal  Requirements. 

History 
1 .  Repealer  filed  6-22-87;  operative  7-22-87  (Register  87,  No.  27). 

§  50007.     Fiscal  Intermediary. 

Fiscal  intermediary,  as  used  in  these  regulations  or  in  any  other  docu- 
ment pertaining  to  the  Medi-Cal  program  and  its  administration,  means 
any  individual,  partnership  or  association,  corporation  or  institution  con- 
tracting with  the  Department  for  the  performance  of  fiscal  services  re- 
lated to  the  program. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14000.3  and  14104.3,  Welfare  and  Institufions  Code. 

History 
1.  Change  without  regulatory  effect  adding  NOTE  (Register  86,  No.  49). 

§  50008.    Liens. 

History 

1.  Repealer  filed  12-31-82  as  an  emergency;  effective  upon  filing  (Register  83, 
No.  2).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  4-30-83. 

2.  Certificate  of  Compliance  transmitted  to  OAL  4-29-83  and  filed  6-3-83  (Reg- 
ister 83,  No.  23). 

§  50009.    Medi-Cal  Consultant. 

Medi-Cal  consultant,  as  used  in  these  regulations,  means  the  appropri- 
ate professional  individual  employed  by  the  Department  to  render  advice 
and  determinations  in  matters  related  to  services  provided  under  Medi- 


Page  307 


Register  95,  No.  45;  11-10-95 


§  50009.1 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


Cal.  Appropriate  Medi-Cal  consultants  shall  personally  review  and  sign 
any  document  as  required  by  these  regulations.  Signatory  authority  of  a 
Medi-Cal  consultant  shall  not  be  delegated. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  1411 9,  Welfare  and  Institutions  Code. 

History 

1.  Change  without  regulatory  effect  adding  NOTE  (Register  86,  No.  49). 

§50009.1.    Medical  Review. 

(a)  Medical  review  means  a  periodic,  not  less  than  annual,  evaluation 
of  the  health  needs  of  each  beneficiary  in  each  mental  hospital,  skilled 
nursing  facility  and  intermediate  care  facility.  Medical  Review  is  con- 
ducted by  a  Medical  Review  Team  on  behalf  of  the  Department. 

(b)  Such  review  is  to  determine  the  quality  and  adequacy  of  the  ser- 
vices being  provided  each  beneficiary,  the  level  of  care  required  to  meet 
each  beneficiary's  health  needs  and  the  necessity  and  desirability  of  the 
initial  or  continued  placement  of  such  patient  in  such  facility. 

(c)  The  review  shall  include  a  personal  contact  with  and  observation 
of  each  beneficiary  and  a  review  of  each  beneficiary's  medical  record  by 
a  Team  member  or  members.  The  review  may  include  a  medical  exami- 
nation of  the  beneficiary  by  the  Medi-Cal  consultant  when  the  consultant 
deems  it  necessary. 

NOTE:  Authority  cited:  Sections  10725,  10743  and  14124.5,  Welfare  and  Institu- 
tions Code.  Reference:  Sections  14019.5, 14100.1, 14104  and  141 19,  Welfare  and 
Institutions  Code. 

History 

I .  Change  without  regulatory  effect  adding  NOTE  (Register  86,  No.  49). 

§  50009.2.    Medical  Review  Team. 

A  Medical  Review  Team  shall  be  comprised  of  a  physician  and  other 
appropriate  health  and  social  service  personnel  necessary  to  conduct 
medical  review. 

NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14100.1, 14104,  141 19  and  14133.1,  Welfare  and  Insti- 
tutions Code. 

History 
1.  Change  without  regulatory  effect  adding  NOTE  (Register  86,  No.  49). 

§  50009.3.    Health  Care  Services. 

Health  care  services  means  the  medical  services,  social  services,  sup- 
plies, devices,  drugs  and  any  other  medical  care  to  which  an  eligible  per- 
son is  entitled  pursuant  to  these  regulations. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14021,  14053,  14132  and  14136,  Welfare  and  Institu- 
tions Code. 

History 
1.  Change  without  regulatory  effect  adding  NOTE  (Register  86,  No.  49). 


Chapter  2.    Determination  of  Medi-Cal 
Eligibility  and  Share  of  Cost 


Article  1. 


Definitions,  Abbreviations  and 
Program  Terms 


§  5001 1 .    Definitions — General. 

The  definitions  in  this  article  shall  apply  to  Chapter  2  of  this  division 
unless  the  context  requires  otherwise. 

NOTE:  Authority  cited  for  Chapter  2:  Sections  10554.1  and  14124.5,  Welfare  and 
Institutions  Code.  Reference  Sections  17.1,  10000,  10002,  10020, 10021,  10022, 
10023,  10024,  10025,  10052,  10058,  10554.1,  10555,  10600,  10608,  10800, 

10800.1,  10803,  10806,  10809,  10850,  10851,  10852,  10853,  10900,  10950, 
10951, 10952, 10953, 10954, 10956, 10957, 10958, 10959,  10960, 10961, 10962, 
10963,  10964,  10965,  11000,  11002,  11003,  11004,  11005.5,  11008,  11008.2, 
11008.6,  11008.7,  11008.9,  11008.10,  11018,  11050,  11051,  11052,  11053, 
11054,  11055,  11057,  11100,  11102,  11150,  11151,  11152,  11153.7,  11155, 
11157,  11158,  11205,  11257,  11452,  12150,  12152,  12305,  13000,  14000, 

14000.2,  14001,  14002,  14003,  14005,  14005.1,  14005.4,  14005.7,  14005.8, 
14005.9,  14005.12,  14005.13,  14006,  14007,  14008,  14008.5,  14009,  14011, 
14012,  14013,  14014,  14015,  14016,  14017,  14018,  14019,  14023,  14026, 


14050.1,  14050.2,  14050.3.  14051,  14052.  14053.  14054.  14057.  14061.  14062, 
14063,  14100.1,  14103.6, 14104.3,  I4I09, 141 12, 14115, 14119.  14122. 14124.5, 
14133,  14140,  14141,  14142,  14143,  14144,  14201  and  14252,  Welfare  and  Insti- 
tutions Code  and  Chapter  2,  Part  1,  Division  1,  Article  3.1,  Section  306  et  seq.. 
Health  and  Safety  Code. 

History 
1 .  Repealer  of  Chapter  2  (Sections  50024-50750,  not  consecutive)  and  new  Chap- 
ter 2  (Sections  5001 1-50955,  not  consecutive)  filed  12-20-76  as  an  emergen- 
cy; designated  effective  1-1-77.  Certificate  of  Compliance  included  (Register 
76.  No.  52).  For  history  of  former  Chapter  2,  see  Resisters  66,  Nos.  6,  19,  30; 
67,  Nos.  23,  34,  52;  68,  Nos.  21.43;  69,  Nos.  3,  31;  70,  No.  27;  71,  Nos.  40,  52; 
72,  Nos.  5.  1 8.  27,  3 1 ,  40,  52;  73.  Nos.  4,  1 8.  1 9.  22.  26,  36,  41 ,  52;  74,  Nos.  3, 
)  8,  41,  45.  46;  75,  Nos.  6,  17,  23,  32,  48;  76,  Nos.  14,  27,  29,  43. 

§50012.     Abbreviations. 

The  following  abbreviations  shall  apply  to  chapter  2  of  this  division: 

ABD.  Aged,  Blind  or  Disabled. 

ABD-MN.        Aged,  Blind  or  Disabled — Medically  Needy. 

AFDC.  Aid  to  Families  with  Dependent  Children. 

AFDC-MN.     Aid  to  Families  with  Dependent  Children — 
Medically  Needy. 

BRU.  Benefits  Review  Unit. 

CETA.  Comprehensive  Employment  and  Training  Act. 

CHDP.  Child  Health  and  Disability  Prevention  Program. 

EAS.  Eligibility  and  Assistance  Standards  Manual. 

ETS.  Employment  Training  Services. 

HlC.  Social  Security  Health  Insurance  Claim  Number. 

INS.  Immigration  and  Naturalization  Service. 

LTC.  Long-Term  Care. 

MBSAC.  Minimum  Basic  Standard  of  Adequate  Care. 

MFBU.  Medi-Cal  Family  Budget  Unit. 

MI.  Medically  Indigent. 

MN.  Medically  Needy. 

OASDI.  Old  Age  Survivors  and  Disability  Insurance. 

Other  PA.         Other  Public  Assistance. 

PA.  Public  Assistance. 

PCCM.  Primary  Care  Case  Management. 

PHP.  Prepaid  Health  Plan. 

POE.  Proof  of  Eligibility. 

SDX.  State  Data  Exchange. 

SSN.  Social  Security  Number. 

SSI/SSP.  Supplemental  Security  Income/State  Supplemental 

Program. 

UIB.  Unemployment  Insurance  Benefits. 

WIN.  Work  Incentive  Program. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.1,  14050.1  and  14088,  Welfare  and  Institutions 
Code. 

History 

1.  Amendment  filed  3-5-81;  effective  thirtieth  day  thereafter  (Register  81,  No. 
10). 

2.  Amendment  filed  7-31-81  as  an  emergency;  effective  upon  filing  (Register  81, 
No.  33).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  1 1-28-81. 

3.  Certificate  of  Compliance  transmitted  to  OAL  11-6-81  and  filed  1-27-82 
(Register  82,  No.  5) 

4.  Amendment  filed  3-9-90  as  an  emergency;  operative  3-9-90  (Register 90,  No. 
12).  A  Certificate  of  Compliance  must  be  transmitted  to  OM^  within  120  days 
or  emergency  language  will  be  repealed  on  7-9-90. 

5.  Amendment  refiled  7-9-90  as  an  emergency;  operative  7-9-90  (Register  90, 
No.  35).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  by  operation  of  law  on  1 1-6-90. 

6.  Request  to  readopt  amendment  on  an  emergency  basis  pursuant  to  Government 
Code  section  11346.1  granted  and  filed  11-6-90  as  an  emergency;  operative 
1 1-6-90  (Register  91 ,  No.  6).  A  Certificate  of  Compliance  must  be  transmitted 
to  OAL  by  3-6-91  or  emergency  language  will  be  repealed  by  operation  of  law 
on  the  following  day. 

7.  Certificate  of  Compliance  as  to  1 1-6-90  order  transmitted  to  OAL  2-22-91 ; 
disapproved  by  OAL  on  3-25-91  (Register  91,  No.  18). 

8.  Amendment  filed  3-25-91  as  an  emergency;  operative  3-25-91  (Register  91, 
No.  18).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  7-23-91 
or  emergency  language  will  be  repealed  by  operation  of  law  on  the  following 
day. 


Page  308 


Register  95,  No.  45;  11-10-95 


Title  22 


Health  Care  Services 


§  50025.3 


• 


9.  Certificate  of  Compliance  as  to  3-25-9 1  order  transmitted  to  OAL  7-19-91  and 
filed  8-19-91  (Register  92,  No.  1). 

§50013.    Adequate  Consideration. 

Adequate  consideration  means  the  receipt  of  cash  or  property  which 
is  fair  and  reasonable  under  the  circumstances  considering  the  net  market 
value  of  properly  that  is  sold,  converted  or  transferred. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14015,  Welfare  and  Institutions  Code. 

History 
1 .  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§50014.     Adult. 

(a)  Adult  means: 

(1)  A  person  who  is  21  years  of  age  or  older. 

(2)  A  blind  or  disabled  MN  person  who  is  18  to  21  years  of  age,  living 
in  the  home  of  a  parent  and  not  currently  enrolled  in  school,  college,  uni- 
versity, or  a  course  of  vocational  or  technical  training  to  prepare  him/her 
for  gainful  employment. 

(3)  A  person  who  is  1 8  to  21  years  of  age,  who  is  not  living  in  the  home 
of  a  parent  or  caretaker  relative,  is  not  claimed  as  a  tax  dependent  of  his/ 
her  parent(s)  and  is  not  receiving  out-of-home  care  from  a  public 
agency. 

(4)  A  person  14  to  18  years  of  age  who  is  not  living  in  the  home  of  a 
parent  or  caretaker  relati  ve  and  who  does  not  have  a  parent,  caretaker  rel- 
ative or  legal  guardian  handling  any  of  his/her  financial  affairs. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Secfions  14005.4,  14005.7, 14008  and  14010,  Welfare  and  Insti- 
tutions Code. 

History 

1 .  Amendment  filed  1-8-81 ;  effecfi  ve  thirtieth  day  thereafter  (Register  81 ,  No.  2). 

2.  Amendment  of  subsection  (a)(2),  repealer  of  subsection  (a)(3),  subsection  re- 
numbering, amendment  of  newly  designated  subsection  (a)(4),  and  amendment 
of  Note  filed  12-9-97;  operative  1-8-98  (Register  97,  No.  50). 

§50015.    Adverse  Action. 

(a)  Adverse  action  means  an  action  taken  by  a  county  department 
which  discontinues  Medi-Cal  eligibility  or  increases  an  MFBU's  share 
of  cost.  The  following  shall  not  be  considered  to  be  adverse  actions: 

(1)  Discontinuance  due  to  any  of  the  following  reasons: 

(A)  Death,  for  a  one-person  MFBU. 

(B)  The  whereabouts  of  the  beneficiary  is  unknown  and  the  post  office 
has  returned  county  department  mail  directed  to  the  beneficiary  indicat- 
ing no  forwarding  address. 

(C)  Admission  to  an  institution  which  renders  the  beneficiary  ineligi- 
ble. 

(D)  The  beneficiary  also  has  Medi-Cal  eligibility  under  another  iden- 
tity or  category,  or  in  another  county  or  state;  or  will  have  such  dual  eligi- 
bility as  of  the  first  of  the  coming  month  if  discontinuance  action  is  not 
taken. 

(E)  Receipt  of  the  beneficiary's  clear  and  signed  written  statement  that 
does  either  of  the  following: 

1.  States  the  beneficiary  no  longer  wishes  Medi-Cal  benefits. 

2.  Gives  information  that  requires  discontinuance  and  includes  the 
beneficiary's  acknowledgment  that  this  must  be  the  consequence  of  sup- 
plying such  information. 

(2)  An  increase  in  an  MFBU's  share  of  cost  due  to  either  of  the  follow- 
ing: 

(A)  The  voluntary  inclusion  of  eligible  family  members  who  currently 
are  not  receiving  benefits  under  any  Medi-Cal  program. 

(B)  Receipt  of  the  beneficiary's  clear  and  signed  statement  which 
gives  information  which  requires  an  increase  in  the  share  of  cost  and  in- 
cludes the  beneficiary's  acknowledgment  that  this  must  be  the  conse- 
quence of  supplying  such  information. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Insfitutions 
Code.  Reference:  Sections  10721,  10950  and  11050,  Welfare  and  Insfitutions 
Code. 

History 
1 .  Amendment  filed  12-15-77;  effective  thirtieth  day  thereafter  (Register  77,  No. 
51). 


2.  Amendment  filed  5-30-80  as  an  emergency;  effective  upon  filing  (Register  80, 
No.  22).  A  Certificate  of  Compliance  must  be  transmitted  to  OAH  within  120 
days  or  emergency  language  will  be  repealed  on  9-27-80. 

3.  Certificate  of  Compliance  filed  9-26-80  (Register  80,  No.  39). 

4.  Amendment  of  subsection  (a)(2)(A)  filed  7-9-87:  operative  8-8-87  (Register 
87,  No.  30). 

§50016.     Aid. 

Aid  means  cash  assistance,  food  stamps  or  Medi-Cal. 
NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14050.2,  Welfare  and  Institutions  Code. 

History 

1.  Editorial  con-ection  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50017.    Aid  Category. 

Aid  category  means  the  specific  category  under  which  a  person  is  eli- 
gible to  receive  Medi-Cal. 

§50018.    Aid  Code. 

Aid  code  means  the  two-digit  number  which  indicates  the  aid  category 
under  which  a  person  is  eligible. 

§  50019.    Aid  to  Families  with  Dependent  Children  (AFDC). 

Aid  to  Families  with  Dependent  Children  (AFDC)  means  the  public 
assistance  program  that  provides  a  cash  grant  and  Medi-Cal  to  children 
deprived  of  parental  support  or  care  and  their  eligible  relatives. 

§  50020.     Aid  to  the  Potentially  Self-Supporting  Blind 
(APSB). 

NOTE:  Authority  cited:  Sections  10725,  and  14124.5,  Welfaie  and  Insfitutions 
Code.  Reference:  Secfions  14005.1,  and  14050.1,  Welfare  and  Insfitufions  Code. 

History 

1 .  Repealer  filed  7-31-81  as  an  emergency;  effective  upon  filing  (Register  8 1 ,  No. 
33)  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  1 1-28-81 . 

2.  Certificate  of  CompHance  transmitted  to  OAL  11-6-81  and  filed  1-27-82 
(Register  82,  No.  5). 

§50021.     Applicant. 

Applicant  means  the  individual  or  family  making,  or  on  whose  behalf 
is  made,  an  applicafion,  request  for  restoradon  of  aid  or  reapplication. 

§  50022.     Application. 

Applicafion  means  a  written  request  for  aid. 

§  50023.    Approval  of  Eligibility. 

Approval  of  eligibility  means  the  determination  made  by  the  county 
department  that  a  person  or  family  is  eligible  for  Medi-Cal. 

§  50024.     Beneficiary. 

Beneficiary  means  a  person  who  has  been  determined  eligible  for 

Medi-Cal. 

NOTE:  Authority  cited;  Sections  10725  and  14124.5,  Welfare  and  Institufions 
Code.  Reference:  Secfion  14252,  Welfare  and  Insfitutions  Code. 

History 

1 .  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50025.     Benefits  Review  Unit  (BRU). 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Insfitufions 
Code.  Reference:  Section  14016,  Welfare  and  Institutions  Code. 

History 

1 .  Editorial  correcfion  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

2.  Repealer  filed  7-3-86;  effective  thirtieth  day  thereafter  (Register  86,  No.  27). 

§  50025.3.     Board  and  Care. 

(a)  Board  and  care  means  receipt  of  board,  room,  personal  care  and 
designated  supplemental  services  related  to  individual  needs  in  one  of  the 
following  nonmedical  protective  living  environinents  certified  in  accor- 
dance with  HAS  46-325.3  for  a  full  calendar  month: 

(1)  A  licensed  residential  care  facility. 

(2)  The  home  of  a  relative  or  legally  appointed  guardian  or  conserva- 
tor, other  than  the  home  of  a  spouse  or  the  home  of  a  parent  for  a  blind 
or  disabled  child. 


Page  309 


Register  97,  No.  50;  12-12-97 


§  50025.5 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


(3)  A  home  in  which  a  child  is  placed  by  a  court  under  Welfare  and 
Institutions  Code  727(a). 

(4)  An  exclusive  use  home  approved  by  a  licensed  home  finding 
agency. 

NOTE:  Authority  cited:  Seclion.s  10725  and  14124.5,  Welfare  and  lnstitution.s 
Code.  Reference:  Section  14005.13,  Welfaie  and  Institutions  Code. 

History 
1 .  New  section  filed  1  -8-81 ;  effective  thirtieth  day  thereafter  (Register  81 .  No.  2). 

§  50025.5.     Burial  Insurance. 

Burial  insurance  means  insurance  which  by  its  terms  can  only  be  used 
to  pay  the  burial  expenses  of  the  insured. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 

1 .  New  .section  filed  3-7-80;  as  an  emergency;  effective  upon  filing  (Register  80, 
No.  9).  A  Certificate  of  Compliance  must  be  transmitted  to  OAH  within  120 
days  or  emergency  language  will  be  repealed  on  7-6-80. 

2.  Certificate  of  Compliance  filed  6-6-80  (Register  80,  No.  23). 

3.  Editorial  cortcction  of  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50025.6.    California  Standard  Nomenclature  (CSN),  1979. 

NOTE:  Authority  cited:  Section  57(c),  Chapter  328,  Statutes  of  1982;  Section 
14124.5,  Welfare  and  Institutions  Code.  Reference:  Sections  14132,  14133  and 
14122.1.  Welfare  and  Institutions  Code;  and  Section  53.  Chapter  328.  Statutes  of 
1982. 

History 

1 .  New  section  filed  6-24-83  as  an  emergency;  effective  upon  filing  (Register  83, 
No.  26).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  10-22-83. 

2.  Certificate  of  Compliance  transmitted  to  OAL  10-21-83  and  filed  11-23-83 
(Register  83,  No.  48). 

3.  Editorial  correction  renumbering  Section  50025.6  to  Section  51050  filed 
12-20-83  (Register  83,  No.  52). 

§  50026.     Cash  Grant. 

Cash  grant  means  the  money  payment  made  to  a  person  eligible  for 
AFDC,  EVH  or  SSI/SSP. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.1  and  14050.1,  Welfare  and  Institutions  Code. 

History 

1.  Amendment  filed  7-31-81  as  an  emergency;  effective  upon  filing  (Register  81, 
No.  33)  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  1 1-28-81 . 

2.  Certificate  of  Compliance  transmitted  to  OAL  11-6-81  and  filed  1-27-82 
(Register  82,  No.  5). 

§  50027.    Certification  Date  for  Claims  Clearance. 

Certification  date  for  claims  clearance  means  the  date  of  the  most  re- 
cent service  listed  on  the  Record  of  Health  Care  Costs,  MC  177S  or  MC 
177P. 

§  50028.    Certification — Effective  Date. 

Effective  date  of  certification  for  Medi-Cal  means  the  date  the  person 
is  certified  to  receive  Medi-Cal  benefits. 

§  50029.    Certification  for  Medi-Cal. 

Certification  for  Medi-Cal  means  the  determination  by  the  county  de- 
partment or  the  Department  that  a  person  is  eligible  for  Medi-Cal  and  has 
no  share  of  cost,  has  met  the  share  of  cost  or  is  in  long-term  care  and  has 
a  share  of  cost  which  is  less  than  the  cost  of  long-term  care  at  the  Medi- 
Cal  rate. 

§  50029.5.    Certified  Long-Term  Care  Insurance  Policy  or 
Certificate. 

Certified  Long-Term  Care  Insurance  Policy  or  Certificate  means  any 
long-term  care  insurance  policy  or  certificate  certified  by  the  Depart- 
ment of  Health  Services  and  approved  for  issue  or  delivery  to  California 
residents  by  the  Department  of  Insurance  as  meeting  the  requirements  set 
forth  in  Section  22005(e)  of  the  Welfare  and  Institutions  Code. 
NOTE:  Authority  cited:  Section  22009(a),  Welfare  and  Institutions  Code.  Refer- 
ence: Sections  22004,  22005  and  22006,  Welfare  and  Institutions  Code. 


History 

1.  New  section  filed  1 1-1-93  as  an  emergency:  operative  1 1-1-93  (Register  93, 
No.  45).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  3-1-94 
or  emergency  language  will  be  repealed  by  operation  of  law  on  the  following 
day. 

2.  Certificate  of  Compliance  as  to  1 1-1-93  order  transmitted  to  OAL  2-1 7-94  and 
filed  3-31-94  (Register  94,  No.  1 3). 

§50030.    Child. 

(a)  Child  means  a  person  under  the  age  of  21  except  for  those  persons 
who  are  specified  as  adults  in  Section  50014. 

(b)  An  unborn  is  considered  a  child  for  Medi-Cal  purposes. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5.  Welfare  and  Institutions 
Code.  Reference:  Sections  12305,  12305.5.  14001,  14005.1,14005.4,  14005.7, 
14008,  14010,  14011, 14017,  14018,  14051,  14051.5,  and  14052,  Welfare  and  In- 
stitunons  Code;  Sections  25.6,  34.7.  34.9  and  34.10,  Civil  Code. 

History 

1.  Amendment  of  subsection  (a)(3)  filed  10-31-78  as  an  emergency;  designated 
effective  1 1-1-78  (Register  78,  No.  44). 

2.  Certificate  of  Compliance  filed  2-6-79  (Register  79,  No.  6). 

3.  Amendment  filed  1-8-8 1 ;  effective  thirtieth  day  thereafter  (Register  8 1,  No.  2). 

4.  Amendment  of  subsection  (a),  repealer  of  subsections  (a)(  I  )-(a)(4)  and  amend- 
ment of  Note  filed  12-9-97;  operative  1-8-98  (Register  97,  No.  50). 

§  50031 .    Child  Health  and  Disability  Prevention  Program 
(CHDP). 

Child  Health  and  Disability  Prevention  Program  (CHDP)  means  the 
community  based  program  for  early  identification  and  referral  for  treat- 
ment of  persons  under  21  years  of  age  with  potentially  handicapping  con- 
ditions. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Insfitutions 
Code.  Reference;  Sections  14053  and  14100.1,  Welfare  and  Institutions  Code; 
Section  320,  Health  and  Safety  Code. 

History 

1.  Editorial  cortection  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50032.    Competent. 

Competent  means  being  able  to  act  on  one's  own  behalf  in  business 
and  personal  matters. 

§  50033.    Contiguous  Property. 

Contiguous  property  means  adjacent  or  adjoining  property  that  is  not 
separated  by  a  road,  street,  right  of  way  or  in  any  other  manner  from  prop- 
erty being  considered. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 

1.  Editorial  con-ection  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50034.     Conversion  of  Property. 

Conversion  of  property  means  changing  property  from  one  form  to 
another  without  changing  ownership. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14006  and  14015,  Welfare  and  Insfitutions  Code. 

History 
1.  Editorial  con-ection  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50035.    County  Agency. 

County  agency  means  either  an  administrative  division  of  a  county 
government  or  a  noncounty  organization  that  has  a  contract  with  the 
county  to  act  on  the  county's  behalf. 

§  50035.5.    County  Cash-Based  Medi-Cal  Eligibility. 

County  cash-based  Medi-Cal  eligibility  means  eligibility  for  Medi- 
Cal  benefits  which  is  based  upon  a  county  department  determination  of 
eligibility  for  a  cash  grant  or  IHSS. 

NoTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Insfitutions 
Code.  Reference:  Sections  14005.1  and  14050.1,  Welfare  and  Institutions  Code. 

History 
1.  New  section  filed  3-5-81;  effective  thirtieth  day  thereafter  (Register  81,  No. 

10). 


Page  310 


Register  97,  No.  50;  12-12-97 


Title  22 


Health  Care  Services 


§  50043 


§  50036.    County  Department. 

County  department  means  the  department  authorized  by  the  county 
board  of  supervisors  to  administer  aid  programs,  including  Medi-Cal. 

§  50036.5.     County  Case  Error  Rate. 

The  county  case  error  rate  means  the  number  of  quality  control  case 
reviews  found  in  error  divided  by  tiie  total  number  of  completed  case  re- 
views in  that  county,  exclusive  of  state  caused  errors. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  ln.stitutions 
Code.  Reference:  Section  14016(g),  Welfare  and  Institutions  Code. 

History 

1 .  New  section  filed  7-6-83  as  an  emergency;  elfective  upon  filing  (Register  83, 
No.  33).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  1 1-3-83. 

2.  Certificate  of  Compliance  transmitted  to  OAL  11-3-83  and  filed  12-6-83 
(Register  83,  No.  50). 

3.  Corrected  Certificate  of  Compliance  as  to  7-6-83  order  filed  1-9-84  (Register 
84,  No.  2). 

4.  Amendment  filed  5-15-92;  operative  6-15-92  (Register  92,  No.  21). 

§  50036.6.     Dependent  Relative. 

NOTE;  Authority  cited:  Sections  10725, 14006.1  and  14124.5,  Welfare  and  Insti- 
tutions Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 

1 .  New  section  filed  7-24-84  as  an  emergency;  effective  upon  filing  (Register  84, 
No.  31).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  1 1-21-84. 

2.  Order  of  Repeal  of  7-24-84  emergency  order  filed  12-20-84  by  OAL  pursuant 
to  Government  Code  Section  1 1349.6  (Register  84,  No.  51). 

§  50037.    Eligibility  and  Assistance  Standards  Manual 
(HAS). 

Eligibility  and  Assistance  Standards  Manual  (EAS)  means  the  portion 
of  the  Manual  of  Policies  and  Procedures  published  by  the  State  Depart- 
ment of  Benefit  Payments  which  includes  regulations  pertaining  to  the 
AFDC,  APSB,  SSP  and  EVH  programs. 

§  50037.5.    Eligibility  Quality  Control. 

(a)  Eligibility  quality  control  means  both  of  the  following: 

(1)  Federally  mandated  review  of  Medi-Cal  cases  to  ensue  proper  de- 
termination of  eligibility. 

(2)  State  mandated  review  of  Medi-Cal  cases  within  individual  coun- 
ties to  ensure  proper  determination  of  eligibility. 

NOTE:  Authority  cited:  Secdons  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14016  (b),  (d)  and  (e)(1)  and  14100.1,  Welfare  and  In- 
stitutions Code. 

History 

1 .  New  section  filed  7-6-83  as  an  emergency;  effective  upon  filing  (Register  83, 
No.  33).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  1 1-3-83. 

2.  Certificate  of  Compliance  transmitted  to  OAL  11-3-83  and  filed  12-6-83 
(Register  83,  No.  50). 

3.  Corrected  Certificate  of  Compliance  as  to  7-6-83  order  filed  1-9-84  (Register 
84,  No.  2). 

§  50038.    Eligibility  Services. 

Eligibility  services  means  those  services  provided  by  the  county  de- 
partment relating  to  the  initial  and  continuing  determination  of  a  person's 
or  family's  Medi-Cal  eligibility. 

§  50038.5.     Emergency  Assistance  (EA). 

(a)  Emergency  Assistance  (EA)  means  the  public  assistance  programs 
that  provide  assistance  for  30  days  to: 

(1)  Families  not  meeting  the  qualifications  for  the  federal  AFDC-U 
program. 

(2)  Those  children  who  are  being,  or  are  in  immediate  danger  of  being 
abused,  neglected  or  exploited  and  to  families  of  such  children. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  and  Section  87(c),  Chapter  1594,  Statutes  of  1982.  Reference:  Sections 
11250.5,  1 1406.5  and  14005.1,  Welfare  and  Institutions  Code;  and  Department  of 
Social  Services  Manual  of  Policies  and  Procedures,  EiigibiUty  and  Assistance 
Standards,  Section  45-401.2  (incorporated  into  Title  22,  California  Administra- 
tive Code). 


History 

1.  New  section  filed  12-31-82  as  an  emergency;  effective  upon  filing  (Register 
83,  No.  2).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  4-30-83. 

2.  Certificate  of  Compliance  transmitted  to  OAL  4-13-83  and  filed  5-16-83 
(Register  83,  No.  21). 

3.  Editorial  coirection  of  subsecfions  (a)(1)  and  (2)  filed  5-16-83  (Register  83, 
No.  21), 

§  50039.    Encumbrances  of  Record. 

Encumbrances  of  record  means  obligations  for  which  property  is  secu- 
rity, as  evidenced  by  a  written  document. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 

1.  Editorial  cortection  adding  NOTE  filed  7-7-83  (Register  83.  No.  29). 

2.  Amendment  filed  6-3-87;  operative  7-3-87  (Register  87,  No.  24). 

§  50040.    Fair  Market  Value. 

NOTE:  Authority  cited:  Sections  10725,  14006.1  and  14124.5,  Welfare  and  Insti- 
tutions Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 

1 .  New  section  filed  7-24-84  as  an  emergency;  effective  upon  filing  (Register  84, 
No.  31).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  1 1-21-84. 

2.  Order  of  Repeal  of  7-24-84  emergency  order  filed  12-20-84  by  OAL  pursuant 
to  Government  Code  Section  11349.6  (Register  84,  No.  51). 

§  50041 .    Family  Member. 

(a)  Family  member  means  the  following  persons  living  in  the  home: 

(1)  A  child  or  sibling  children. 

(2)  The  parents  married  or  unmarried  of  the  sibling  children. 

(3)  The  stepparents  of  the  sibling  children. 

(4)  The  separate  children  of  either  unmarried  parent  or  of  the  parent 
or  stepparent. 

(b)  If  there  are  no  children,  family  member  means  a  single  person  or 
a  married  couple. 

NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Insfitutions 
Code.  Reference-.  Sections  14051,  14052  and  14008,  Welfare  and  Institutions 
Code. 

History 
1 .  Amendment  filed  1-8-81 ;  effective  thirtieth  day  thereafter  (Register  81,  No.  2). 

§  50041 .5.    Federal  Poverty  Level. 

The  federal  poverty  level  means  an  income  level  based  on  the  official 
poverty  line  as  defined  by  the  federal  Office  of  Manageinent  and  Budget 
and  revised  annually  or  at  any  shorter  interval  the  Secretary  of  Health  and 
Human  Services  deems  feasible  and  desirable  pursuant  to  Section 
9902(2).  Title  42,  United  States  Code. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  and  Section  12,  Chapter  1430,  Statutes  of  1989.  Reference:  Section 
14005.3,  Welfare  and  Institutions  Code;  and  Section  9902(2),  Title  42,  United 
States  Code. 

History 

1.  New  section  filed  10-3-94  as  an  emergency;  operative  10-3-94  (Register  94, 
No.  40).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  1-31-95 
or  emergency  language  will  be  repealed  by  operation  of  law  on  the  following 
day. 

2.  Editorial  coiTection  of  History  Note  1  (Register  95,  No.  9). 

3.  Repealed  by  operation  of  Government  Code  secfion  1 1346.1(g)  (Register  95, 
No.  9). 

4.  New  section  refiled  3-3-95  as  an  emergency;  operative  3-3-95  (Register  95, 
No.  9).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  7-1-95  or 
emergency  language  will  be  repealed  by  operation  of  law  on  the  following  day. 

5.  Certificate  of  Compliance  as  to  3-3-95  order  including  amendment  of  section 
transmitted  to  OAL  2-22-95  and  filed  4-5-95  (Register  95,  No.  14). 

§50042.    Foster  Child. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4  and  14005.7,  Welfare  and  Institutions  Code. 

History 

1 .  Repealer  filed  8-8-80;  effective  thirtieth  day  thereafter  (Register  80,  No.  32). 

§50043.    Heirloom. 

Heirloom  means  any  item  of  personal  property,  other  than  cash  and  se- 
curities, which  has  substantially  sentimental  value,  has  been  owned  by 


Page  311 


Register  97,  No.  50;  12-12-97 


§  50044 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


a  family  lor  ai  least  two  generations  and  is  intended  to  be  retained  by  the 
family  in  succeeding  generations. 

§  50044.    Home. 

Home  means  real  or  personal  property,  fixed  or  mobile,  located  on 
land  or  water,  in  which  a  person  or  family  lives. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 

1.  Editorial  conection  adding  NOTE  filed  7-7-83  (Register  83.  No.  29). 

§  50045.    immigration  and  Naturalization  Service  (INS). 

Immigration  and  Naturalization  Service  (INS)  means  the  branch  of  the 
United  States  Government  that  administers  regulations  regarding  aliens 
in  the  United  States. 

§  50045.1 .    Impairment  Related  Work  Expenses  (IRWE). 

"Impairment  Related  Work  Expenses"  (IRWE)  means  those  expenses 
of  a  working  disabled  QMB  or  SLMB  program  applicant/beneficiary 
which  are  necessary  to  become  or  remain  employed.  Such  expenses  in- 
clude but  are  not  limited  to  expenses  which  are: 

(a)  Required  to  control  a  disabling  condition,  thereby  enabling  the  in- 
dividual to  work; 

(b)  Essential  to  meet  the  functional  demands  of  a  job,  e.g.,  wheel- 
chairs, respirators,  prosthesis,  attendant  care; 

(c)  Necessary  in  preparing  for  work,  in  traveling  to  and  from  work,  or 
assistance  needed  immediately  upon  returning  from  work  (e.g.,  attendant 
care  services,  transportation  costs,  exterior  ramps,  and  railing  or  path- 
ways modified  to  the  exterior  of  the  applicant'  s/beneficiary '  s  residence). 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  ]382a(b)  and  1396a(a),  Title  42,  United  States  Code; 
and  Section  14005.1 1,  Welfare  and  Institutions  Code. 

History 

1.  New  section  filed  8-13-90  as  an  emergency;  operative  8-13-90  (Register  90, 
No.  40).  A  Cenificate  of  Compliance  must  be  transmitted  to  OAL  by  12-1 1-90 
or  emergency  language  will  be  repealed  by  operation  of  law  on  the  following 
day. 

2.  Certificate  of  Compliance  transmitted  to  OAL  12-11-90  and  filed  1-9-91 
(Register9I,No.  8). 

3.  Amendment  of  opening  statement  filed  12-21-93;  operative  1-20-94  (Register 
93,  No.  52). 

§  50045.3.    Income  and  Eligibility  Verification  System. 

The  Income  and  Eligibility  Verification  System  (lEVS)  is  the  federal- 
ly mandated  system  established  to  obtain,  use  and  verify  information 
relevant  to  determination  of  eligibility  and  share  of  cost. 
NOTE:  Authority  cited:  Sections  10725,  10740  and  14124.5,  Welfare  and  Institu- 
tions Code.  Reference:  Sections  1 1025,  14001  and  14016.9,  Welfare  and  Institu- 
tions Code;  and  42  Code  of  Federal  Regulations  435.940. 

History 

I.  New  section  filed  7-16-87;  operative  7-16-87  pursuant  to  Government  Code 
Section  11346.2(d)  (Register  87,  No.  30). 

§  50045.5.    In-Home  Supportive  Services. 

In-Home  Supportive  Services  (IHSS)  means  the  social  services  pro- 
gram which  provides  necessary  personal  and  domestic  care  so  that  aged, 
blind  and  disabled  persons  may  remain  in  their  own  homes. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institufions 
Code.  Reference:  Sections  12305,  12305.5,  14001,  14005.1,  14005.4,  14005.7, 
14008,  14008.5,  14010,  14011,  14017,  14018  and  14051.5,  Welfare  and  Institu- 
tions Code;  Sections  25.6,  34.5,  34.7,  34.9  and  34.10,  Civil  Code. 

History 

1.  New  section  filed  10-31-78  as  an  emergency;  designated  effective  11-1-78 
(Register  78,  No.  44). 

2.  Certificate  of  Compliance  filed  2-6-79  (Register  79,  No.  6). 

§  50046.    Inmate. 

Inmate  means  a  person  living  or  being  cared  for  in  an  institution.  Ex- 
cluded from  this  definition  are  persons  residing  at  a  facility  for  vocational 
training  or  educational  purposes,  and  persons  temporarily  in  an  institu- 
tion pending  more  suitable  arrangements,  such  as  children  in  a  local 
agency  facility  pending  foster  care  placement. 


NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  11014,  11016  and  14053,  Welfare  and  Institutions 
Code. 

History 
1.  Amendment  filed  4-1-83;  effective  thirtieth  day  thereafter  (Register  83,  No. 
14). 

§  50047.     Institution. 

Institution  means  an  establishment  which  provides  food  and  shelter  to 
four  or  more  persons  unrelated  to  the  proprietor  and  in  addition  provides 
some  treatment  or  services  which  meet  needs  beyond  the  basic  provision 
of  food  and  shelter. 

§  50048.    Institution— Medical. 

Medical  institution  means  any  public  or  private  acute  care  hospital, 
acute  psychiatric  hospital,  intermediate  care  facility,  skilled  nursing  fa- 
cility, or  other  medical  facility  licensed  by  an  officially  designated  state 
standard  setting  authority. 

§  50049.     Institution — Mental  Diseases. 

An  institution  for  mental  diseases  means  an  institution  primarily  en- 
gaged in  providing  diagnosis,  treatment  or  care  for  persons  with  mental 
illness. 

§  50050.    Institution — Nonmedical. 

Nonmedical  institution  means  any  institution  providing  nonmedical 
residential  care,  custodial  care,  custody  or  restraint.  This  includes  penal 
institutions. 

§50051.    Institution— Private. 

A  private  institution  means  a  proprietary  or  nonprofit  facility  managed 
and  controlled  by  an  individual,  private  association  or  corporation. 

§  50052.    Institution— Public. 

Public  institution  means  an  institution  that  is  the  responsibility  of  a 
governmental  unit  or  over  which  a  governmental  unit  exercises  adminis- 
trative control.  Excluded  from  this  definition  are  medical  facilities  and 
publicly  operated  community  residences  designed  to  serve  and  serving 
no  more  than  sixteen  persons. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  InstiUitions 
Code.  Reference:  Sections  11014,  11016  and  14053,  Welfare  and  Institutions 
Code. 

History 
1.  Amendment  filed  4-1-83;  effective  thirtieth  day  thereafter  (Register  83,  No. 
14). 

§  50052.5.    Institution — Tuberculosis. 

Tuberculosis  institution  means  an  institution  which  is  primarily  en- 
gaged in  providing  diagnosis,  treatment  or  care  of  persons  with  tubercu- 
losis, including  medical  attention,  nursing  care  and  related  services. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14053(1 4)(b),  Welfare  and  Institutions  Code. 

History 
1 .  New  section  filed  3-7-80;  effective  thirtieth  day  thereafter  (Register  80,  No.  9). 

§  50053.    Intraprogram  Status  Change. 

Intraprogram  status  change  means  a  change  in  a  person's  or  family's 
eligibility  from  one  aid  category  to  another  aid  category,  in  which  the  first 
digit  of  the  aid  code  remains  the  same. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  10743  and  14100.1,  Welfare  and  Institutions  Code. 

History 
1.  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50054.    Interprogram  Transfer. 

Interprogram  transfer  means  a  transfer  of  eligibility  from  one  aid  cate- 
gory to  another  aid  category,  in  which  the  first  digit  of  the  aid  code 
changes. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  10743  and  14100.1,  Welfare  and  Institutions  Code. 

History 

1 .  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50054.5.     Life  Insurance. 

Life  insurance  means  a  contract  for  which  premiums  are  paid  during 
the  lifetime  of  the  insured,  and  on  which  the  insuring  company  pays  the 


Page  312 


Register  97,  No.  50;  12-12-97 


Title  22 


Health  Care  Services 


§  50060.6 


face  amount  of  the  policy  to  the  beneficiary  upon  the  death  of  the  insured. 
Life  insurance  may  also  be  purchased  by  a  single  premium  or  by  letting 
dividends  accumulate. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  1 1 158  and  14006,  Welfare  and  Institutions  Code. 

History 

1 .  New  section  filed  3-7-80  as  an  emergency;  effective  upon  filing  (Register  80, 
No.  9).  A  Certificate  of  Compliance  must  be  transmitted  to  OAH  within  120 
days  or  emergency  language  will  be  repealed  on  7-6-80. 

2.  Certificate  of  Compliance  filed  6-6-80  (Register  80,  No.  23). 

§  50054.7.    Limited  Service  Status. 

Limited  service  status  means  that  the  beneficiary's  use  of  the  Medi- 
Cal  card  is  limited  because  of  enrollment  in  a  noncomprehensive  PHP  or 
PCCM  plan,  improper  utilization  of  service,  application  as  a  child  under 
Section  50147.1  or  participation  in  a  pilot  project  conducted  by  the  De- 
partment. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  1 40 1 0.  1 40 1 7,  1 4088. 1 6  and  1 4088.4,  Wei  fare  and  In- 
stitutions Code. 

History 

1.  New  section  filed  8-8-80;  effective  thirtieth  day  thereafter  (Register  80,  No. 
32). 

2.  Amendment  filed  3-9-90  as  an  emergency;  operative  3-9-90  (Register  90,  No. 
12).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  7-9-90. 

3.  Amendment  refiled  7-9-90  as  an  emergency;  operauve  7-9-90  (Register  90, 
No.  35).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  by  operation  of  law  on  1 1-6-90. 

4.  Request  to  readopt  amendment  on  an  emergency  basis  pursuant  to  Government 
Code  section  1 1346.1  granted  and  filed  1 1-6-90  as  an  emergency;  operative 
1 1-6-90  (Regisler91 ,  No.  6).  A  Certificate  of  Compliance  must  be  transmitted 
to  OAL  by  3-6-91  or  emergency  language  will  be  repealed  by  operation  of  law 
on  the  following  day. 

5.  Certificate  of  Compliance  as  to  1 1-6-90  order  transmitted  to  OAL  2-22-91 ; 
disapproved  by  OAL  on  3-25-91  (Register  91,  No.  18). 

6.  Amendment  filed  3-25-91  as  an  emergency;  operative  3-25-91  (Register  91, 
No.  18).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  7-23-91 
or  emergency  language  will  be  repealed  by  operation  of  law  on  the  following 
day. 

7.  Certificate  of  Compliance  as  to  3-25-9 1  order  transmitted  to  OAL  7-19-91  and 
filed  8-19-91  (Register  92,  No.  1). 

§  50055.    Linked. 

Linked  means  meeting  the  SSI/SSP  requirements  of  age,  blindness  or 
disability  or  the  AFDC  requirements  of  deprivation  of  parental  support 
or  care. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.7  and  14051,  Welfare  and  Institutions  Code. 

History 

1.  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50056.    Long-Term  Care  (LTC). 

Long-term  care  (LTC)  means  inpatient  medical  care  which  lasts  for 
more  than  the  month  of  admission  and  is  expected  to  last  for  at  least  one 
full  calendar  month  after  the  month  of  admission. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institufions 
Code.  Reference:  Section  14050.3,  Welfare  and  Institutions  Code. 

History 
1.  Editorial  con:ection  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50057.    Marriage. 

Marriage  means  the  state  of  being  married,  including  a  legal  common 
law  marriage,  as  defined  in  Section  4100  et  seq.,  Chapter  2,  Division  4, 
Part  5,  Title  I,  California  Civil  Code. 

§  50058.    IVIedi-CaL 

Medi-Cal  means  California's  medical  assistance  program  and  the 
benefits  available  under  that  program. 

§  50059.    Medi-Cal  Card. 

Medi-Cal  card  means  a  computer  printed  or  hand  typed  card  issued 
each  month  to  a  person  certified  to  receive  Medi-Cal  in  order  to  identify 


the  person  as  a  Medi-Cal  beneficiary  and  authorize  the  receipt  of  Medi- 
Cal  covered  services  by  that  person. 

§  50059.5.    State  Dollar  Error  Rate. 

The  state  dollar  error  rate  means  the  Medicaid  dollar  error  rate  re- 
ported to  the  Department  by  the  United  States  Department  of  Health  and 
Huinan  Services,  less  any  portion  of  this  error  rate  attributable  to  state 
caused  errors. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14016(g),  Welfare  and  Institutions  Code. 

History 

1 .  New  section  filed  7-6-83  as  an  emergency;  effective  upon  filing  (Register  83, 
No.  33).  A  Certificate  of  Compliance  must  be  transinitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  1 1-3-83. 

2.  Certificate  of  Compliance  transmitted  to  OAL  11-3-83  and  filed  12-6-83 
(Register  83,  No.  50). 

3.  Coirected  Ceitificate  of  Compliance  as  to  7-6-83  order  filed  1-9-84  (Register 

84,  No.  2). 

4.  Amendment  filed  5-15-92;  operafive  6-15-92  (Register  92,  No.  21). 

§  50059.6.     Federal  Standard. 

"Federal  standard"  means  the  Medicaid  dollar  error  rate  standard  to 
which  the  State  is  held  accountable  by  the  Federal  Government. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14016(g),  Welfare  and  Institutions  Code. 

History 

1 .  New  section  filed  8-23-83  as  an  emergency;  effective  upon  filing  (Register  83, 
No.  38).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  12-21-83. 

2.  Certificate  of  Compliance  filed  12-12-83  (Register  83,  No.  50). 

3.  Amendment  filed  5-15-92;  operative  6-15-92  (Register  92,  No.  21). 

§  50059.7.    State  Caused  Errors. 

State  caused  errors  means  case  errors  in  a  county  for  which  the  state 
assumes  responsibility. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14016(g),  Welfare  and  Institutions  Code. 

History 
1.  New  section  filed  5-15-92;  operative  6-19-92  (Register  92,  No.  21). 

§  50060.    Medi-Cal  Family  Budget  Unit  (MFBU). 

Medi-Cal  Family  Budget  Unit  (MFBU)  means  the  persons  who  will 
be  included  in  the  Medi-Cal  eligibility  and  share  of  cost  determination. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4,  14005.7  and  14008,  Welfare  and  Institutions 
Code. 

History 
1.  Editorial  con-ection  of  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50060.5.    Medi-Cal-Only  Eligibility. 

Medi-Cal-only  eligibihty  means  a  person's  or  family's  eligibility  for 
Medi-Cal  benefits  that  has  been  determined  independently  of  an  eligibil- 
ity determination  for  any  other  aid  or  benefit  program. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14005,  Welfare  and  Institutions  Code. 

History 

1.  New  section  filed  8-7-78;  effective  thirtieth  day  thereafter  (Register  78,  No. 

32). 

2.  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50060.6.    Medical  Support. 

Medical  support  is  any  liability  or  payment  for  the  purpose  of  medical 
care  available  under  a  court  or  administrative  order,  including  but  not 
limited  to  health  insurance,  specific  dollar  amounts  for  medical  purposes, 
and  payments  for  medical  care  from  any  third  party. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14008.6,  14023  and  14024,  Welfare  and  Institutions 
Code;  42  CFR,  Section  301.1. 

History 

1.  New  section  filed  4-16-93  as  an  emergency;  operative  4-16-93  (Register  93, 
No.  16).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  8-16-93  or 
emergency  language  will  be  repealed  by  operaUon  of  law  on  the  following  day. 

2.  Certificate  of  Compliance  as  to  4-16-93  order  transmitted  to  OAL  8-13-93  and 
filed  9-23-93  (Register  93,  No.  39). 


Page  313 


Register  97,  No.  50;  12-12-97 


§  50061 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


§  50061 .    Medically  Indigent  (Ml)  Person  or  Family. 

Medically  indigent  (MI)  person  or  family  means  a  person  or  family  eli- 
gible under  the  Medically  Indigent  program. 

§  50062.    Medically  Needy  (MN)  Person  or  Family. 

Medically  needy  (MN)  person  or  family  means  a  person  or  family  eli- 
gible under  the  Medically  Needy  program. 

§  50063.    Minimum  Basic  Standard  of  Adequate  Care 
(MBSAC). 

Minimum  Basic  Standard  of  Adequate  Care  (MBSAC)  means  the 
amount  necessary  to  provide  an  AFDC  family  with  basic  needs  as  speci- 
fied in  the  HAS  manual. 

§  50063.5.     Minor  Consent  Services. 

(a)  Minor  consent  services  means  services  related  to: 

(1)  Sexual  assault. 

(2)  Drug  or  alcohol  abuse  for  children  12  years  of  age  or  older. 

(3)  Pregnancy. 

(4)  Family  planning. 

(5)  Venereal  disease  for  children  12  years  of  age  or  older. 

(6)  Sexually  transmitted  diseases  designated  by  the  Director  for  chil- 
dren 12  years  of  age  or  older. 

(7)  Mental  health  care  for  children  1 2  years  of  age  or  older  who  are  ma- 
ture enough  to  participate  intelligently  and  which  is  needed  to  prevent  the 
children  from  seriously  harming  themselves  or  others  or  because  the  chil- 
dren are  the  alleged  victims  of  incest  or  child  abuse. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14010,  Welfare  and  Institutions  Code;  and  Sections  25.9 
and  34.7,  Civil  Code. 

History 

1.  New  section  filed  4-28-82;  effective  thirtieth  day  thereafter  (Register  82,  No. 
18). 

§  50064.    Multiple  Dwelling  Unit. 

Multiple  dwelling  unit  means  any  dwelling  with  more  than  one  sepa- 
rate living  unit,  that  is,  a  unit  which  normally  would  include  as  a  mini- 
mum a  bathroom  and  a  kitchen. 

§  50064.5.    Nonrecurring  Lump  Sum  Payment. 

Nonrecurring  lump  sum  payment  means  a  payment  accrued  over  more 
than  one  calendar  month  and  not  expected  to  be  received  again  in  the  fu- 
ture. It  does  not  include  the  amount  of  the  monthly  benefit  normally  at- 
tributable to  the  month  for  which  eligibility  is  being  determined. 

History 
1 .  New  section  filed  1 2-15-77;  effective  thirtieth  day  thereafter  (Register  77,  No. 

51). 

§  50065.    Obligate. 

Obligate  means  to  incur  a  cost  for  health  care  services. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.9  and  14019.3,  Welfare  and  Institutions  Code. 

History 
1.  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50066.    Other  Public  Assistance  (Other  PA)  Recipient. 

Other  Public  Assistance  (Other  PA)  recipient  means  a  person  ehgible 
for  Medi-Cal  under  one  of  the  categories  in  the  Other  Public  Assistance 
program. 

§  50067.    Overpayment. 

Overpayment  means  the  receipt  of  Medi-Cal  benefits  when  there  is  no 
entitlement  to  all  or  a  portion  of  the  benefits  received. 
NotE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14009,  14014,  14023  and  14024,  Welfare  and  Institu- 
tions Code. 

History 
1.  Editorial  correction  adding  NOTE  fUed  7-7-83  (Register  83,  No.  29). 

§  50068.     Parent. 

Parent  means  the  natural  or  adoptive  parent  of  a  child. 


NOTE:  Authority  cited:  Sections  10725  and  14124.5.  Welfare  and  Institutions 
Code.  Reference:  Sections  14008.  14051  and  14052,  Welfaie  and  Institutions 
Code. 

History 
1.  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50068.5.    Parent— Minor. 

Minor  parent  means  a  person  who  meets  the  definition  of  a  child  and 
has  his  or  her  own  child  or  children  living  in  the  home. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5.  Welfare  and  Institutions 
Code.  Reference:  Sections  14008,  14010.  14051  and  14052,  Welfare  and  Institu- 
tions Code. 

History 
1 .  New  section  filed  12-9-97;  operative  1-8-98  (Register  97,  No,  50). 

§  50069.    Parents — Unmarried. 

Unmarried  parents  means  parents  who  are  living  together  with  their 

common  child  and  the  parents  are  not  married  to  each  other. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14008,  14051  and  14052,  Welfaie  and  Institutions 
Code. 

History 

1.  Editorial  con-ection  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50069.5.    Parent— Unmarried  Minor. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14008,  14051  and  14052,  Welfare  and  Institutions 
Code. 

History 

1 .  New  section  filed  1-8-81 ;  effective  thirtieth  day  thereafter  (Register  81,  No.  2). 

2.  Repealer  filed  12-9-97;  operative  1-8-98  (Register  97,  No.  50). 

§  50070.     Patient. 

Patient  means  a  person  receiving  individual  professional  services  di- 
rected by  a  licensed  practitioner  of  the  healing  arts  towards  maintenance, 
improvement,  or  protection  of  health,  or  the  alleviation  of  disability  or 
pain. 

§  50071 .    Persons  Living  in  the  Home. 

(a)  Persons  living  in  the  home  means  all  of  the  following: 

(1)  Persons  physically  present  in  the  home; 

(2)  Persons  temporarily  absent  from  the  home  because  of  hospitaliza- 
tion, visiting,  vacation,  trips  in  connection  with  work,  or  because  of  simi- 
lar reasons  as  Umited  by  (d). 

(3)  Persons  away  at  school  or  vocational  training  who  will  resume  liv- 
ing in  the  home  as  evidenced  by  the  person  returning  home  for  vacations, 
weekends  and  at  other  times. 

(b)  A  temporary  absence  is  normally  one  in  which  the  person  leaves 
and  returns  to  the  home  in  the  same  month  or  the  following  month. 

(c)  Whether  a  person  is  living  in  the  home  while  in  LTC  or  board  and 
care  shall  be  determined  in  accordance  with  Section  50-577. 

(d)  A  child,  other  than  specified  in  (e),  temporarily  absent  from  the 
home  in  accordance  with  (a)(2)  shall  be  considered  to  be  living  in  the 
home  as  long  as  the  parent  continues  to  have  responsibility  for  the  care 
and  control  of  the  child.  A  parent  continues  to  have  responsibility  for  the 
care  and  control  of  a  child  until  the  court  removes  this  responsibility  or 
the  parent  voluntarily  relinquishes  it  in  accordance  with  Department  of 
Social  Services,  Manual  of  Policies  and  Procedures,  Division  30. 

(e)  The  home  in  which  a  child  shall  be  determined  in  accordance  with 
Section  50374  when  both  of  the  following  conditions  exist: 

(1)  The  child  stays  alternately  for  periods  of  one  month  or  less  with 
each  of  his/her  parents. 

(2)  The  child's  parents  are  separated  or  divorced. 

(f)  An  18  to  21  year  old  or  unmarried  minor  parent  living  on  the  par- 
ent's property  shall  not  be  considered  to  be  living  in  the  parent's  home 
if  both  of  the  following  conditions  exist: 

(1)  The  18  to  21  year  old  or  unmarried  minor  parent  does  not  receive 
any  support  from  the  parents. 

(2)  The  building  the  18  to  21  year  old  or  unmarried  minor  parents  lives 
in  would  be  considered  other  real  property  of  the  parents. 


Page  314 


Register  97,  No.  50;  12-12-97 


Title  22 


Health  Care  Services 


§  50076 


(g)  A  person  whose  institutional  status  results  in  ineligibility  for 
Medi-Cal  shall  not  be  considered  to  be  living  in  the  home  during  any  full 
month  of  institutionalization. 

Note-.  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14008  and  14051,  Welfare  and  Institutions  Code. 

History 

1 .  Amendment  filed  1-8-81 ;  effective  thirtieth  day  thereafter  (Register  81 ,  No.  2). 

2.  Amendment  of  subsection  (c)  filed  2-11-82;  effective  thirtieth  day  thereafter 
(Register  82,  No.  7). 

3.  New  subsection  (f)  filed  4-1-83;  effective  thirtieth  day  thereafter  (Register  83, 
No.  14). 

4.  Amendment  of  subsection  (d),  relettering  of  former  subsections  (e)  and  (f)  to 
subsections  (f)  and  (g)  and  new  subsection  (e)  filed  4-17-89;  operative 
5-17-89  (Register  89,  No.  48). 

§  50071 .5.     Prepaid  Health  Plan. 

(a)  Prepaid  health  plan  means  any  health  care  service  plan  as  defined 
in  Health  and  Safety  Code  Section  1345  (0  which: 

(1)  Is  licensed  as  a  health  care  service  plan  by  the  Commissioner  of 
Corporations  pursuant  to  the  Knox-Keene  Health  Care  Service  Plan  Act 
of  1975,  Chapter  2.2,  commencing  with  Section  1340,  Division  2,  Health 
and  Safety  Code,  or  has  an  application  for  licensure  pending  and  was  reg- 
istered under  the  Knox-Mills  Health  Plan  Act  prior  to  its  repeal  in  Chap- 
ter 941,  Statutes  of  1975. 

(2)  Meets  the  requirements  for  participation  in  the  Medicaid  Program, 
Title  XIX  of  the  Social  Security  Act,  on  an  at  risk  basis. 

(3)  Has  a  contract  with  the  Department  to  furnish  directly  or  indirectly 
health  services  to  Medi-Cal  beneficiaries  on  a  predetermined  periodic 
rate  basis. 

(b)  The  term  "prepaid  health  plan"  does  not  include  any  pilot  program 
contract  entered  into  pursuant  to  Article  7,  commencing  with  Section 
14490,  Chapter  8,  Part  3,  Division  9,  Welfare  and  Institutions  Code. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14016.5,  Welfare  and  Institufions  Code. 

History 

1.  New  section  filed  8-8-80;  effective  thirtieth  day  thereafter  (Register  80,  No. 

32). 

§  50071.6.    Prepaid  Health  Plan — Comprehensive. 

Comprehensive  prepaid  health  plan  means  a  prepaid  health  plan  that 
is  required  by  contract  with  the  Department  to  provide  the  full  scope  of 
benefits  available  under  the  Medi-Cal  program. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14016.5,  Welfare  and  Institutions  Code. 

History 
1.  New  section  filed  8-8-80;  effective  thirtieth  day  thereafter  (Register  80,  No. 

32). 

§  50071 .8.    Primary  Care  Case  Management  (PCCM)  Plan. 

Primary  care  case  management  plan  or  PCCM  plan  means  any  person 
or  organization  who: 

(a)  Has  entered  into  a  contract  with  the  Department  on  a  capitated  or 
risk  sharing  basis,  or  both,  to  provide  or  arrange  for  the  provision  of 
health  care  services  under  the  provisions  of  Article  2.9  commencing  with 
section  14088,  Welfare  and  Institutions  Code;  and 

(b)  Meets  the  requirements  for  participation  in  the  Medicaid  Program, 
as  stated  in  Title  XIX  of  the  Social  Security  Act,  on  an  at-risk  basis. 
NOTE:  Authority  cited:  Sections  10725,  14105  and  14124.5,  Welfare  and  Institu- 
tions Code.  Reference:  Sections  14088, 14088. 16  and  14088.2,  Welfare  and  Insti- 
tutions Code. 

History 

1 .  New  section  filed  3-9-90  as  an  emergency,  operafive  3-9-90  (Register  90,  No. 
12).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  7-9-90. 

2.  New  section  refiled  7-9-90  as  an  emergency;  operative  7-9-90  (Register  90, 
No.  35).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  by  operation  of  law  on  1 1-6-90. 

3.  Request  to  readopt  section  on  an  emergency  basis  pursuant  to  Government  Code 
section  1 1346. 1  granted  and  filed  1 1-6-90  as  an  emergency;  operative  1 1-6-90 
(Register  91,  No.  6).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL 
by  3-6-91  or  emergency  language  will  be  repealed  by  operafion  of  law  on  the 
following  day. 


4.  Certificate  of  Compliance  as  to  1 1-6-90  order  transmitted  to  OAL  2-22-91; 
disapproved  by  OAL  on  3-25-91  (Register  91,  No.  1 8). 

5.  New  section  filed  3-25-91  as  an  emergency;  operative  3-25-91  (Register  91, 
No.  1 8).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  7-23-91 
or  emergency  language  will  be  repealed  by  operation  of  law  on  the  following 
day. 

6.  Certificate  of  Compliance  as  to  3-25-91  order  including  amendment  of  section 
transmitted  to  OAL  7-19-91  and  filed  8-19-91  (Register  92,  No.  1). 

§  50072.     Property — Community. 

Community  property  means  property  acquired  by  either  spouse  during 
marriage,  unless  the  property  was  acquired  as  separate  property  or  with 
funds  that  can  be  identified  as  separate  property. 

NOTE;  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Secfions  14006  and  14008,  Welfare  and  Institutions  Code. 

History 

1.  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50073.     Property— Personal. 

Personal  property  means  possessions  or  interests,  exclusive  of  real 
property,  that  may  be  easily  transported  or  stored;  including  but  not  lim- 
ited to  cash  on  hand,  bank  accounts,  notes,  mortgages,  deeds  of  trust,  cash 
surrender  value  of  life  insurance,  motor  vehicles,  uncollected  judgments, 
an  interest  in  a  firm  in  receivership,  a  lawsuit,  patents  and  copyrights. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14006,  Welfare  and  Insfitutions  Code. 

History 
1 .  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50074.     Property— Real. 

Real  property  means  land  and  improvements  which  generally  includes 
any  immovable  property  attached  to  the  land  and  any  oil,  mineral,  timber 
or  other  rights  related  to  the  land. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Insfitutions 
Code.  Reference:  Secfion  14006,  Welfare  and  Institutions  Code. 

History 

1.  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50075.     Property— Separate. 

(a)  Separate  property  means  any  item  that  is  considered  separate  prop- 
erty under  California  Property  Law.  Generally,  separate  property  is  prop- 
erty acquired  by  an  individual  by  any  method  prior  to  marriage,  after  ob- 
taining an  interlocutory  or  final  judgment  of  dissolution,  or  while 
voluntarily  separated;  or  at  any  time  by  gift  or  inheritance,  or  purchases 
made  with  funds  that  are  separate  property  or  with  funds  from  the  sale  of 
separate  property. 

(b)  Separate  property  also  includes  that  portion  of  a  couple's  former 
community  property  which  has  been  transmuted  into  separate  property 
by  a  written  interspousal  agreement  in  accordance  with  50403(c). 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Insfitutions 
Code.  Reference:  Secfions  14006,  14006.2  and  14008,  Welfare  and  Institutions 
Code. 

History 

1 .  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

2.  New  subsection  (b)  filed  2-16-88  as  an  emergency;  operative  2-16-88  (Regis- 
ter 88,  No.  1 0).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within 
120  days  or  emergency  language  will  be  repealed  on  6-15-88. 

3.  New  subsection  (b)  refiled  6-1 6-88  as  an  emergency;  operative  6-1 6-88  (Reg- 
ister 88,  No.  26).  A  Certificate  of  Compliance  must  be  transtnitted  to  OAL  with- 
in 120  days  or  emergency  language  will  be  repealed  on  10-14-88. 

4.  Emergency  language  of  subsection  (b)  refiled  and  operafive  6-16-88  repealed 
on  l(>^]4-88  by  operation  of  Government  Code  Section  1 1346.1  (Register  88, 

No.  49). 

5.  New  subsection  (b)  filed  1 1-16-88;  operative  1 1-16-88  pursuant  to  Govern- 
ment Code  Secfion  11346.2(d)  (Register  88,  No.  49). 

§  50076.     Property— Share  of  Community. 

For  the  purpose  of  determining  Medi-Cal  eligibility,  share  of  commu- 
nity property  is  to  be  treated  as  if  each  spouse  owns  one-half  of  the  com- 
munity property. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Insfitutions 
Code.  Reference:  Section  14006,  Welfare  and  Institufions  Code. 


Page  315 


Register  97,  No.  50;  12-12-97 


§  50077 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


History 
1 .  Amendment  filed  2-1 1-82;  effective  thirtieth  day  thereafter  (Register  82.  No. 

7). 

§  50077.     Public  Agency. 

Public  agency  means  an  administrative  division  of  local,  state  or  feder- 
al government,  or  an  organization  that  has  a  contract  to  act  in  behalf  of 
the  local,  state  or  federal  government. 

§  50078.     Public  Assistance  (PA)  Recipient. 

Public  assistance  (PA)  recipient  means  a  person  or  family  receiving 
assistance  under  the  AFDC,  SSI/SSP,  Indochinese  refugee  or  Cuban  ref- 
ugee program. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.1  and  14050.1,  Welfare  and  Institutions  Code. 

History 

1.  Amendment  filed  8-7-78;  effective  thirtieth  day  thereafter  (Register  78,  No. 

32). 

2.  Amendment  filed  7-31-81  as  an  emergency;  effective  upon  filing  (Register  81 , 
No.  33).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  1 1-28-81. 

3.  Certificate  of  Compliance  transmitted  to  OAL  1 1-6-81  and  filed  1-27-82 
(Register  82,  No.  5). 

§  50079.     Public  Funds. 

Public  funds  means  monies  provided  by  local,  state  or  federal  govern- 
ment. 

§  50079.5.    Publicly  Operated  Community  Residence. 

(a)  Publicly  operated  community  residence  means  a  facility  designed 
and  planned  to  serve  no  more  than  16  residents  which  is  actually  serving 
16  or  fewer  residents.  The  facility  provides  food  and  shelter  and  must 
provide  some  additional  services  such  as: 

(1)  Social  services. 

(2)  Help  with  personal  activities. 

(3)  Training  in  socialization  and  life  skills. 

(b)  Excluded  from  this  definition  are: 

(1)  Residential  facilities  located  on  the  grounds  or  immediately  adja- 
cent to  any  large  institution  or  multi-purpose  complex. 

(2)  Educational  or  vocational  training  facilities. 

(3)  Correctional  or  holding  facilities  for  persons  detained  under  the  pe- 
nal system. 

(4)  Medical  treatment  facilities. 

Note;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  11014,  11016  and  14053,  Welfare  and  Institutions 
Code. 

History 
1.  New  section  filed  4-1-83;  effective  thirtieth  day  thereafter  (Register  83,  No. 
14). 

§  50079.6.     Qualified  Disabled  and  Working  Individual. 

"Qualified  Disabled  and  Working  Individual"  ineans  an  individual 
who  meets  the  eligibility  criteria  for  the  Qualified  Disabled  and  Working 
Individual  program  specified  in  Section  50256. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  and  Section  12,  Chapter  1430,  Statutes  of  1989.  Reference:  Section 
14005.3,  Welfare  and  Institutions  Code;  and  Sections  1396a(a)(10)(E)  and 
1396d(s),  Title  42,  United  States  Code. 

History 

1.  Renumbering  of  former  section  50079.6  to  section  50079.7  and  new  section 
filed  10-3-94  as  an  emergency;  operafive  10-3-94  (Register  94,  No.  40).  A 
Certificate  of  Compliance  must  be  transmitted  to  OAL  by  1  -31-95  or  emergen- 
cy language  will  be  repealed  by  operation  of  law  on  the  following  day.  For  prior 
history,  see  Register  91,  No.  8. 

2.  Editorial  correction  of  History  Note  1  (Register  95,  No.  9). 

3.  Reinstatement  of  section  as  it  existed  prior  to  emergency  filed  3-2-95  by  opera- 
tion of  Government  Code  secfion  1 1346.1(f)  (Register  95,  No.  9). 

4.  Renumbering  of  former  secdon  50079.6  to  section  50079.7  and  new  section  re- 
filed  3-3-95  as  an  emergency;  operative  3-3-95  (Register95,  No.  9).  A  Certifi- 
cate of  Compliance  must  be  transmitted  to  OAL  by  7-1-95  or  emergency  lan- 
guage will  be  repealed  by  operation  of  law  on  the  following  day. 

5.  Certificate  of  Compliance  as  to  3-3-95  order  including  amendment  of  Note 
transmitted  to  OAL  2-22-95  and  filed  4-5-95  (Register  95,  No.  14). 


§  50079.7.    Qualified  Medicare  Beneficiary. 

"Qualified  Medicare  Beneficiary"  ineans  an  individual  who  meets  the 
eligibility  criteria  for  the  Qualified  Medicare  Beneficiary  program  speci- 
fied in  Section  50258. 

NOTE;  Authority  cited:  Sections  10725, 14005.1 1  and  14124.5,  Welfare  and  Insfi- 
tutions  Code;  and  Section  12.  Chapter  1430,  Statutes  of  1989.  Reference:  Section 
]396d(p),  Title  42,  United  States  Code;  and  Section  14005.1 1,  Welfare  and  Insti- 
tutions Code. 

History 

1 .  Renumbering  of  former  section  50079.6  to  new  section  50079.7  filed  10-3-94 
as  an  emergency;  operative  10-3-94  (Register  94,  No.  40).  A  Certificate  of 
Compliance  must  be  transmitted  to  OAL  by  1-31-95  or  emergency  language 
will  be  repealed  by  operation  of  law  on  the  following  day. 

2.  Editorial  correction  of  History  Note  1  (Register  95,  No.  9). 

3.  Repealed  by  operation  of  Government  Code  section  11346.1(2)  (Register  95, 
No.  9). 

4.  Renumbering  of  former  section  50079.6  to  section  50079.7  and  new  section  re- 
filed  3-3-95  as  an  emergency;  operative  3-3-95  (Register  95.  No.  9).  A  Certifi- 
cate of  Compliance  must  be  transmitted  to  OAL  by  7-1-95  or  emergency  lan- 
guage will  be  repealed  by  operation  of  law  on  the  following  day. 

5.  Certificate  of  Compliance  as  to  3-3-95  order  transmitted  to  OAL  2-22-95  and 
filed  4-5-95  (Register  95,  No.  14). 

§  50080.    Quality  Control. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14016(b),  (d)  and  (e)(1)  and  14100.1,  Welfare  and  In- 
stitutions Code. 

History 

1.  Repealer  filed  7-6-83  as  an  emergency;  effective  upon  filing  (Register  83,  No. 
33).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  11-3-83. 

2.  Certificate  of  Compliance  u-ansmitted  to  OAL  1 1-3-83  and  filed  2-6-83  (Reg- 
ister 83,  No.  50). 

3.  Corrected  Certificate  of  Compliance  as  to  7-6-83  order  filed  1-9-84  (Register 
84,  No.  2). 

§50081.    Reapplication. 

Reapplication  means  an  application  for  Medi-Cal-only  eligibility 
made  in  the  same  county  as  a  previous  application,  if  the  previous  appli- 
cation was  denied  or  withdrawn,  or  Medi-Cal-only  eligibility  based  on 
the  previous  application  has  been  discontinued  for  more  than  12  months. 

History 

1.  Amendment  filed  8-7-78;  effective  thirtieth  day  thereafter  (Register  78,  No. 
32). 

§  50082.     Recipient. 

Recipient  means  a  person  or  family  receiving  aid  under  a  public  assis- 
tance program  or  the  Other  Public  Assistance  program. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.1  and  14050.1,  Welfare  and  Insfitutions  Code. 

History 
1.  Editorial  con-ection  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50083.     Redetermination. 

Redetermination  means  the  review  of  a  person's  or  family's  Medi-Cal 
eligibility. 

§  50084.     Relative. 

Relative  means  a  mother,  father,  grandfather,  grandmother,  son, 
daughter,  brother,  sister,  stepfather,  stepmother,  stepbrother,  stepsister, 
uncle,  aunt,  first  cousin,  nephew,  niece,  half-brother,  half-sister,  any 
such  person  of  a  preceding  or  succeeding  generation  denoted  by  a  prefix 
of  grand,  great  or  great-great  or  the  suffix  in-law. 
NOTE:  Authority  cited:  Secfions  10725, 14006.1  and  14124.5,  Welfare  and  Insti- 
tutions Code.  Reference:  Sections  14005.7, 14006  and  14008,  Welfare  and  Institu- 
tions Code. 

History 

1.  Editorial  cortection  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

2.  Amendment  filed  12-2-85  as  an  emergency;  effective  upon  filing  (Register  85, 
No.  50).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  4-1-86. 

3.  Certificate  of  CompUance  transmitted  to  OAL  3-31-86  and  filed  4-30-86 
(Register  86,  No.  18). 

§  50085.    Relative— Caretaker. 

Caretaker  relative  means  a  relaUve  who  provides  care  and  supervision 
to  a  child,  if  there  is  no  naharal  or  adopUve  parent  in  the  home. 


Page  316 


Register  97,  No.  50;  12-12-97 


Title  22 


Health  Care  Services 


§  50094 


NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14005.7,  Welfare  and  Institutions  Code. 

History 
1 .  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50086.     Repayment. 

Repayment  means  the  liquidation  of  an  overpayment  in  response  to  is- 
suance of  demands  and  recovery  thereof  by  the  Department  of  Benefit 
Payments. 

§  50087.     Residence. 

Residence  means  the  place  in  which  a  person  or  family  lives  oris  phys- 
ically present  if  the  person  or  family  has  no  present  intention  of  leaving. 
NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14007  and  14016,  Welfare  and  Institutions  Code. 

History 

1.  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50088.     Responsible  Relative. 

Responsible  relative  means  a  relative  who  is  responsible  to  contribute 
to  the  cost  of  health  care  services  received  by  a  Medi-Cal  beneficiary. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14008, 14008.5, 14009  and  14010,  Welfare  and  Institu- 
tions Code. 

History 

1.  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50089.     Restoration. 

Restoration  means  the  approval  of  Medi-Cal-only  eligibility  for  a 
person  or  family  in  the  same  county  as  that  in  which  they  were  previously 
ehgible  for  Medi-Cal-only,  if  the  effective  date  of  the  approval  occurs 
within  12  months  of  the  end  of  the  previous  period  of  eligibility. 

History 
1.  Amendment  filed  8-7-78;  effective  thirtieth  day  thereafter  (Register  78,  No. 

32). 

§  50090.    Share  of  Cost. 

Share  of  cost  means  a  person' s  or  family '  s  net  income  in  excess  of  their 
maintenance  need  that  must  be  paid  or  obligated  toward  the  cost  of  health 
care  services  before  the  person  or  family  may  be  certified  and  receive 
Medi-Cal  cards. 


NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.9  and  14054,  Welfare  and  Institutions  Code. 

History 
1.  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50091 .    Share  of  Encumbrances. 

Share  of  encumbrances  means  that  portion  of  the  encumbrances  attrib- 
uted to  each  portion  of  jointly  owned  property. 

§  50091 .5.    Specified  Low-Income  Medicare  Beneficiary. 

"Specified  Low-Income  Medicare  Beneficiary"  (SLMB)  means  an 
individual  who  meets  the  eligibility  criteria  for  the  SLMB  Program  speci- 
fied in  Section  50258.1. 

NOTE:  Authority  cited:  Sections  10725  and  14124,5  of  the  Welfare  and  Institu- 
tions Code.  Reference:  Section  1396a(a)(l  0)(E)(iii),  Title  42,  United  States  Code. 

Hjstory 
1.  New  section  filed  12-21-93;  operative  1-20-94  (Register  93,  No.  52). 

§  50092.    Spenddown. 

Note:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  and  Section  57(c),  Chapter  328,  Statutes  of  1982.  Reference:  Section 
14019.6,  Welfare  and  Institutions  Code. 

History 

1 .  Repealer  filed  8-1 8-82  as  an  emergency;  effecdve  upon  filing  (Register  82,  No. 
34).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  12-16-82. 

2.  Certificate  of  Compliance  transmitted  to  OAL  12-14-82  and  filed  1-21-83 
(Register  83,  No.  4). 

§  50093.    State  Data  Exchange  (SDX). 

State  Data  Exchange  (SDX)  means  the  data  system  by  which  the  Fed- 
eral Government  provides  information  to  the  State  regarding  the  eligibil- 
ity of  SSI/SSP  applicants  and  recipients. 

Note:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Secfion  14017,  Welfare  and  Institutions  Code. 

History 
1.  Editorial  correcfion  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50094.    Stepparent. 

Stepparent  means  a  person  who  is  married  to  the  parent  of  a  child  and 
who  is  not  the  other  parent  of  the  child. 


[The  next  page  is  317.] 


Page  316.1 


Register  97,  No.  50;  12-12-97 


Title  22 


Health  Care  Services 


§  50101 


• 


NOTE;  Authority  cited;  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  1 1261,  14001.1  and  14005.7,  Welfare  and  Institutions 
Code. 

History 

1.  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50095.    Supplemental  Security  Income/State 
Supplemental  Program  (SSI/SSP). 

Supplemental  Security  Income/Slate  Supplemental  Program  (SSI/ 
SSP)  means  the  federal  and  state  payinents,  respectively,  which  are  based 
on  need,  and  are  paid  to  aged,  blind  or  disabled  persons. 

§  50095.1.    Title  II  Disregard  Person. 

NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14005.7,  Welfare  and  Institutions  Code. 

History 

1 .  New  section  filed  1-5-78  as  an  emersency;  effective  upon  filing  (Register  78, 
No.  1). 

2.  Certificate  of  Compliance  filed  5-5-78  (Register  78,  No.  18). 

3.  Renumbering  of  Section  50095.1  to  Section  50095.7  filed  8-9-85  as  an  emer- 
gency; effective  upon  filing  (Register  85,  No.  32).  A  Certificate  of  Compliance 
must  be  transmitted  to  OAL  within  120  days  or  emergency  language  will  be  re- 
pealed on  12-9-85. 

4.  Certificate  of  Compliance  as  to  8-9-85  order  transmitted  to  OAL  1 1-1 3-85  and 
filed  12-1 1-85  (Register  85,  No.  50). 

§  50095.5.    Therapeutic  Wages. 

(a)  Therapeutic  wages  are  wages  earned  by  the  individual  when  all  of 
the  following  conditions  are  met: 

( 1 )  A  physician  who  does  not  have  a  financial  interest  in  the  long-term 
care  facility  in  which  the  individual  resides,  and  who  is  in  charge  of  the 
individual's  case  prescribes  this  work  as  therapy  for  the  individual. 

(2)  The  individual  must  be  employed  by  the  same  long-term  care  facil- 
ity in  which  he  or  she  resides. 

(3)  The  individual's  employment  does  not  displace  any  existing  em- 
ployees. 

(4)  The  individual  has  resided  in  a  long-term  care  facility  continuous- 
ly since  September  1979. 

NOTE;  Authority  cited:  Secfions  10725, 14005. 13  and  14124.5,  Welfare  and  Insn- 
tutions  Code.  Reference:  Section  14005.13,  Welfare  and  Institutions  Code. 

History 

1 .  New  section  filed  8-9-85  as  an  emergency;  effective  upon  filing  (Register  85, 
No.  32).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  12-9-85. 

2.  Certificate  of  Compliance  transmitted  to  OAL  11-13-85  and  filed  12-11-85 
(Register  85,  No.  50). 

§  50095.7.    Title  II  Disregard  Person. 

'Title  II  disregard  person"  means  a  person  who  meets  all  the  condi- 
tions of  Section  50564. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14005.7,  Welfare  and  Institutions  Code. 

History 

1 .  Renumbering  of  Section  50095.1  to  Section  50095.7  filed  8-9-85  as  an  emer- 
gency; effective  upon  filing  (Register  85,  No.  32).  A  Certificate  of  Compliance 
must  be  transmitted  to  OAL  within  120  days  or  emergency  language  will  be  re- 
pealed on  12-9-85.  For  prior  history,  see  Registers  78,  No.  18,  and  78,  No.  1 . 

2.  Certificate  of  Compliance  transmitted  to  OAL  11-13-85  and  filed  12-11-85 
(Register  85,  No.  50). 

§  50096.    Transfer  of  Property. 

Transfer  of  property  means  a  change  in  ownership  whereby  a  person 
no  longer  holds  title  to,  or  beneficial  interest  in,  property. 
NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Insfitutions 
Code.  Reference:  Secfions  14006  and  14015,  Welfare  and  Insfitutions  Code. 

History 
1.  Editorial  correcfion  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50097.    Verification. 

Verification  means  the  process  of  obtaining  acceptable  evidence 
which  substantiates  statements  made  by  an  applicant/beneficiary. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Insfitufions 
Code;  and  Section  57,  Chapter  328,  Statutes  of  1982.  Reference:  Section  1401 1, 
Welfare  and  Institutions  Code. 


History 

1 .  New  section  filed  8-1 8-82  as  an  emergency;  effective  upon  filing  (Register  82. 
No.  34).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  12-16-82. 

2.  Certificate  of  Compliance  transmitted  to  OAL  12-14-82  and  filed  1-21-83 
(Register  83,  No.  4). 


Article  2.    Administration 

§  50101 .    County  Department  Responsibilities. 

(a)  The  county  department  shall: 

(1 )  Be  responsible  for  determining  initial  and  continuing  eligibility  for 
Medi-Cal  applicants  or  beneficiaries  promptly  and  humanely,  in  accor- 
dance with: 

(A)  Medi-Cal  regulations. 

(B)  Departmental  directives. 

(2)  Construe  Medi-Cal  regulations  fairly  and  equitably  when  deter- 
mining Medi-Cal  eligibility. 

(3)  Have  available  at  each  office  copies  of  all  laws,  rules,  regulations 
and  bulletins  relating  to  Medi-Cal. 

(4)  Comply  with  state  hearing  decisions  of  the  Director. 

(5)  Assist  applicants  or  beneficiaries  in  understanding  their  rights  and 
responsibilities  in  relation  to  application  for  Medi-Cal. 

(6)  Evaluate  the  capacity  of  the  applicants  or  beneficiaries  to  discharge 
their  responsibilities  as  set  forth  in  these  regulations. 

(7)  Assist  applicants  or  beneficiaries  as  needed  in  establishing  their 
eligibility. 

(8)  Determine  eligibility,  assess  need,  and  authorize  personal  care  pro- 
gram services  for  eligible  beneficiaries,  as  needed. 

(b)  The  county  department  shall  take  the  following  actions  whenever 
an  applicant  or  beneficiary,  who  is  applying  for  or  receiving  Medi-Cal 
on  behalf  of  a  child  under  eighteen  years  of  age  who  was  born  out  of  wed- 
lock or  who  has  an  absent  parent,  meets  his/her  responsibilities  as  speci- 
fied in  Section  50185  (a)  10. 

(1)  As  soon  as  possible  after  the  applicant's  or  beneficiary's  opportu- 
nity to  claim  good  cause  as  specified  in  50771.5,  and  not  later  than  two 
working  days  after  approval  of  eligibility,  the  county  shall  provide  to  the 
district  attorney  the  following  forms,  whether  or  not  the  Child/Spousal 
and  Medical  Support  Notice  and  Agreement  (CA  2. 1  Notice  and  Agree- 
ment) has  been  completed; 

(A)  A  completed  Referral  to  District  Attorney  (CA  371,  Revised  De- 
cember 1992) 

(B)  A  Child  Support  Questionnaire  (CA  2.1  Q  Support  Questionnaire, 
Revised  March  1993),  if  one  has  been  completed; 

(C)  Health  Insurance  Questionnaire  (DHS  6155,  Revised  October 
1990),  if  one  has  been  completed. 

(D)  Any  other  forms  or  informafion  requested  by  the  district  attorney. 

(2)  If  the  referral  described  in  (1)  above  has  previously  been  provided 
to  the  district  attorney,  the  county  shall  promptly  report  to  the  district  at- 
torney whenever  good  cause  has  been  claimed.  The  district  attorney  will 
suspend  all  acfivities  to  establish  paternity  or  secure  medical  support  un- 
til notified  of  a  final  determination  of  good  cause  by  the  county. 

(3)  The  county  shall  promptly  report  to  the  district  attorney  all  cases 
in  which  it  has  been  determined  that  there  is  or  is  not  good  cause  for  refus- 
al to  cooperate  as  specified  in  Section  50771 .5.  The  district  attorney  will 
not  undertake  to  establish  paternity  or  secure  support  if  there  has  been  a 
finding  of  good  cause  unless  there  also  has  been  a  determination  by  the 
county  that  the  district  attorney  may  proceed  without  the  participation  of 
the  parent  or  caretaker  relafive.  If  there  has  been  such  a  determination, 
the  district  attorney  may  undertake  to  establish  paternity  or  secure  sup- 
port but  may  not  involve  the  parent  or  caretaker  relative. 

(4)  If  the  county  determines  that  the  applicant  or  beneficiary  and  the 
child  on  whose  behalf  the  application  was  filed  are  not  eligible,  the  appli- 
cant or  beneficiary  shall  be  informed  that  he/she  may  go  to  the  district  at- 
torney for  help  in  locating  the  absent  parent(s)  of  the  child,  collecting 
child  and  medical  support  for  the  child,  and  establishing  paternity. 


Page  317 


Register  93,  No.  39;  9-24-93 


§  50103 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


(5)  The  county  shall  provide  the  district  attorney  with  any  information 
requested  concerning  medical  support  cases  and  shall  advise  the  district 
attorney  in  writing  if  any  of  the  following  circumstances  arise: 

(A)  A  person  is  added  to  or  deleted  from  the  MFBU. 

(B)  The  child  ceases  living  with  the  person  who  is  receiving  Medi-Cal 
on  his/her  behalf. 

(C)  A  child  moves  out  of  foster  care  and  begins  living  with  a  parent  or 
relative. 

(D)  A  child  has  been  accepted  for  adoption  by  a  public  or  private  adop- 
tion agency  or  such  an  acceptance  has  been  terminated. 

(E)  Medi-Cal  benefits  have  been  discontinued. 

(6)  If  the  district  attorney  notifies  the  county  that  the  applicant  or  bene- 
ficiary has  not  cooperated,  the  county  shall  verify  the  facts,  determine 
whether  he/she  had  good  cause  for  failure  to  cooperate  pursuant  to  Sec- 
tion 50771.5,  and  notify  the  district  attorney  of  the  determination. 

(7)  Prior  to  making  a  final  determination  of  good  cause  for  refusing  to 
cooperate,  the  county  shall: 

(A)  Afford  the  district  attorney  the  opportunity  to  review  and  comment 
on  the  findings  and  basis  for  the  proposed  determination; 

(B)  Consider  any  recommendation  from  the  district  attorney;  and  from 
any  witnesses  on  behalf  of  the  applicant  in  any  hearing  that  results  from 
an  applicant' s  or  beneficiary' s  appeal  of  any  county  action  relating  to  es- 
tablishing paternity  or  securing  medical  support. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  10000,  10058,  10747,  10800.  10963,  11000,  11490, 
14008.6  and  14016,  Welfare  and  Institutions  Code;  and  42  C.F.R.  Sections 
433.135,  433.136,  433.137,  433.138,  433,145,  433.146,  433.147,  433.148  and 
435.604. 

History 

1.  Amendment  filed  5-30-80  as  an  emergency;  effective  upon  filing  (Register  80, 
No.  22).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  9-27-80. 

2.  Certificate  of  Compliance  filed  9-26-80  (Register  80,  No.  39). 

3.  Amendment  of  subsection  (a)(2)  filed  3-25-83;  effective  thirtieth  day  thereafter 
(Register  83,  No.  13). 

4.  Editorial  correction  of  Note  filed  7-7-83  (Register  83,  No.  29). 

5.  New  subsection  (a)(8)  filed  4-14-93  as  an  emergency;  operative  4-14-93.  Sub- 
mitted to  OAL  for  printing  only  pursuant  to  section  8,  AB  1773  (Chapter  939, 
Statutes  of  1992)  (Register  93,  No.  16). 

6.  New  subsections  (b)-(b)(7)(B)  and  amendment  of  Note  filed  4-16-93  as  an 
emergency;  operative  4-16-93  (Register  93,  No.  16).  A  Certificate  of  Com- 
pliance must  be  transmitted  to  OAL  8-16-93  or  emergency  language  will  be  re- 
pealed by  operation  of  law  on  the  following  day. 

7.  Certificate  of  Compliance  as  to  4-16-93  order  including  amendment  of  subsec- 
tion (b)(1)(C)  and  Note  transmitted  to  OAL  8-1 3-93  and  filed  9-23-93  (Reg- 
ister 93,  No.  39). 


§  501 03.    Civil  Service  or  Merit  Systems. 

All  persons  employed  by  a  county  and  engaged  in  adininistration  of 
the  Medi-Cal  program  shall  be  employed  under  a  civil  service  or  merit 
system  that  meets  the  requirements  established  by  the  California  State 
Personnel  Board. 

§50105.    Staffing  Requirements. 

(a)  Medi-Cal  eligibility  services  may  be  provided  by  personnel  in 
those  technical  nonsocial  work  job  classifications  that  are  established  by 
the  county  personnel  agency  responsible  for  approving  such  job  classifi- 
cation. 

(b)  The  county  department  shall  assign  Medi-Cal  eligibility  staff  in 
sufficient  numbers  so  that  any  applicant  or  beneficiary  in  need  of  eligibil- 
ity services  shall  be  provided  with  those  services. 

(c)  Eligibility  information  shall  be  available  24  hours  a  day,  7  days  a 
week,  to  persons  with  medical  and  related  emergencies. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institudons 
Code.  Reference:  Sections  10809  and  14(X)1,  Welfare  and  Institutions  Code. 

History 

1.  Editorial  con-ection  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 


§50106.    Staff  Training. 

The  county  department  shall  train  Medi-Cal  eligibility  staff  in  accor- 
dance with  the  training  requirements  of  Division  14,  Manual  of  Policies 
and  Procedures,  Department  of  Social  Services. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  10800,  10820,  10900,  10906  and  14001,  Welfare  and 
Institutions  Code. 

History 
1.  Editorial  corteciion  filed  7-7-83  (Register  83,  No.  29). 

§50107.    Civil  Rights. 

(a)  The  county  department  shall  not  discriminate  against  any  applicant 
or  beneficiary  on  the  basis  of  race,  color,  creed,  ethnic  origin,  sex,  marital 
status,  age,  physical  or  mental  handicap,  national  origin  or  political  affili- 
afion. 

(b)  Persons  who  believe  that  they  have  been  discriminated  against  may 
file  a  grievance  with  the  Department  in  accordance  with  departmental 
procedures. 

§50109.    Reports. 

The  county  department  shall  submit  reports  as  required  by  the  Depart- 
ment and  shall  comply  with  such  provisions  as  the  Department  may  find 
necessary  to  ensure  the  correctness  of  the  reports. 

§50110.    Medi-Cal  Case. 

(a)  Each  MFBU  shall  be  one  Medi-Cal  case. 

(b)  Each  Other  PA  person  or  Other  PA  family  group  shall  be  one 
Medi-Cal  case. 

(c)  A  PA  recipient  or  PA  family  group  shall  not  be  a  Medi-Cal  case. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005  and  14008,  Welfare  and  Institutions  Code. 

History 
1.  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  501 1 1 .    Case  Records  and  Confidentiality. 

(a)  The  county  department  shall  adhere  to  the  requirements  in  Divi- 
sions 19  and  23,  Manual  of  Policies  and  Procedures,  Department  of  So- 
cial Services,  governing: 

(1)  Maintenance  of  case  records. 

(2)  Confidentiality  of  case  records. 

(3)  Safeguarding  federal  tax  information. 

(4)  Access  to  case  records. 

(b)  The  board  of  supervisors  of  a  county  may  authorize  the  destruction 
of: 

(1)  Narrative  portions  of  a  case  record  which  are  over  three  years  old 
in  any  case  file,  active  or  inactive,  after  audit  by  the  county  department. 

(2)  Case  files  which  have  remained  inactive  for  a  period  of  three  years 
providing  the  Department  has  not  notified  the  county  department  that  un- 
resolved issues  or  pending  civil  or  criminal  actions  exist. 

NOTE:  Authority  cited:  Sections  10725,  10740  and  14124.5,  Welfare  and  Institu- 
tions Code.  Reference:  Sections  10850-10853,  14001  and  14100.2,  Welfare  and 
Insfitutions  Code;  and  42  Code  of  Federal  Regulations,  431.300  and  431.305. 

History 

1 .  Amendment  filed  3-7-80;  effective  thirtieth  day  thereafter  (Register  80,  No.  9). 

2.  Amendment  of  subsection  (a)  filed  7-16-87;  operative  7-16-87  pursuant  to 
Government  Code  Section  1 1346.2(d)  (Register  87,  No.  30). 

§50113.    Forms. 

(a)  The  county  department  shall  use  the  forms  prescribed  by  the  De- 
partment in  providing  Medi-Cal  eligibility  services. 

(b)  Other  forms  shall  not  be  substituted  by  the  county  department  un- 
less specifically  approved  by  the  Department. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  10820, 1085, 1 1050, 14001  and  1401 1 ,  Welfare  and  In- 
stitutions Code. 

History 
1.  Editorial  con-ection  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  501 1 5.    Quality  Control — County  Cooperation. 

The  county  department  shall  cooperate  with  the  Department  in  ensur- 
ing that  federal  quality  control  requirements  are  met. 


Page  318 


Register  93,  No.  39;  9-24-93 


Title  22  Health  Care  Services  §  50116 

§  501 1 6.     Medi-Cal  Fiscal  Penalties.  Department  staff  of  a  random  sample  of  a  minimum  number  of  cases  for 

(a)  TTie  Department  shall  assess  fiscal  penalties  to  counties  whenever      each  period,  as  follows: 

the  state  dollar  error  rate  exceeds  the  federal  standard.  (1)  All  cases  shall  be  sampled  in  any  county  with  less  than  50  Medi- 

(b)  A  county's  case  error  rate  shall  be  determined  based  on  reviews  by      Cal  cases. 


[The  next  page  is  319.] 


Page  318.1  Register  93,  No.  39;  9-24-93 


Title  22 


Health  Care  Services 


§  50118.5 


• 


(2)  Fifty  cases  in  any  county  with  greater  than  O.OJ  percent  and  less 
than  or  equal  to  0.50  percent  of  the  Medi-Cal  cases  in  the  state. 

(3)  Seventy-five  cases  in  any  county  with  greater  than  0,50  percent 
and  less  than  or  equal  to  1 .0  percent  of  the  Medi-Cal  cases  in  the  state. 

(4)  One  hundred  cases  in  any  county  with  greater  than  1.0  percent  and 
less  than  or  equal  to  3.0  percent  of  the  Medi-Cal  cases  in  the  slate. 

(5)  One  hundred  twenty-five  cases  in  any  county  with  greater  than  3.0 
percent  and  less  than  or  equal  to  10.0  percent  of  the  Medi-Cal  cases  in 
the  state. 

(6)  Six  hundred  fifty  cases  in  any  county  with  greater  than  10.0  percent 
of  the  Medi-Cal  cases  in  the  state. 

(c)  Medi-Cal  fiscal  penalties  established  under  this  Section  shall  ap- 
ply only  to  those  counties  for  which  case  error  rates  are  established. 

(d)  The  Department  shall  determine  which  counties  in  the  state  are  h- 
able  for  fiscal  penalties  as  follows: 

(1)  The  60  percent  of  counties  in  the  state  with  the  highest  case  error 
rates  shall  be  liable  if  the  state's  dollar  error  rate  exceeds  the  federal  stan- 
dard by  0.01  percent  to  1.0  percent. 

(2)  The  70  percent  of  counties  in  the  state  with  the  highest  case  error 
rates  shall  be  liable  if  the  state's  dollar  error  rate  exceeds  the  federal  stan- 
dard by  greater  than  1.0  percent  and  less  than  or  equal  to  2.0  percent. 

(3)  The  80  percent  of  counties  in  the  state  with  the  highest  case  error 
rates  shall  be  liable  if  the  state's  dollar  error  rate  exceeds  the  federal  stan- 
dard by  greater  than  2.0  percent  and  less  than  or  equal  to  3.0  percent. 

(4)  The  90  percent  of  counties  in  the  state  with  the  highest  case  error 
rates  shall  be  liable  if  the  state's  dollar  error  rate  exceeds  the  federal  stan- 
dard by  greater  than  3.0  percent  and  less  than  or  equal  to  4.0  percent. 

(5)  All  counties  in  the  state  shall  be  liable  if  the  state's  dollar  error  rate 
exceeds  the  federal  standard  by  greater  than  4.0  percent. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14016(c),  (e)  and  (g),  Welfare  and  histitutions  Code. 

History 

1.  New  section  filed  7-6-83  as  an  emergency;  effective  upon  filing  (Register  83, 
No.  33).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  1 1-3-83. 

2.  Certificate  of  Compliance  transmitted  to  OAL  11-3-83  and  filed  12-6-83 
(Register  83,  No.  50). 

3.  Corrected  Certificate  of  Compliance  as  to  7-6-83  order  filed  1-9-84  (Register 
84,  No.  2). 

4.  Amendment  filed  5-15-92;  operafive  6-15-92  (Register  92,  No.  21). 

§  50116.5.    Appeal  of  Quality  Control  Review  Findings. 

(a)  When  the  Department  finds  a  sampled  case  that  includes  an  ineligi- 
ble person  or  a  person  with  an  understated  share  of  cost,  written  notifica- 
tion which  describes  the  error  shall  be  sent  to  the  county  department. 

(b)  Tlie  county  department  shall  respond  to  the  Department  in  writing 
within  two  weeks  from  receipt  of  notification  of  the  error  and  shall  indi- 
cate whether  it  agrees  or  disagrees  with  the  findings. 

(c)  If  the  county  disagrees,  the  Department  shall  reevaluate  the  error 
findings,  taking  into  consideration  any  additional  facts  contained  in  the 
county's  response. 

(d)  The  Department  shall  again  notify  the  county  of  the  Department's 
findings. 

(e)  The  county  may  then  appeal  to  the  Chief,  Medi-Cal  Policy  Divi- 
sion, requesting  that  the  Department  review  the  case  and  render  a  final 
decision. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14016(f),  Welfare  and  Institufions  Code. 

History 

1.  New  section  filed  5-15-92;  operafive  6-19-92  (Register  92,  No.  21). 

§  501 1 7.    Calculation  of  Medi-Cal  Fiscal  Penalties. 

(a)  The  Department  shall  calculate  the  fiscal  penalty  for  a  liable  county 
for  each  monitoring  period  as  follows: 

(1)  A  penalty  multiple  shall  be  calculated  by  multiplying  a  county's 
case  error  rate  times  its  percentage  of  statewide  Medi-Cal  cases. 

(2)  A  county's  penalty  multiple  shall  be  divided  by  the  sum  of  the  pen- 
alty multiples  of  all  counties  then  multiplied  times  the  penalty  bank. 


(b)  The  penalty  bank  shall  include  only  quality  control  federal  fiscal 
sanctions,  federal  withholds,  federal  disallowances,  and  any  associated 
General  Fund  expenditures,  minus  the  value  of  any  state  assumed  errors 
and  the  General  Fund  share  of  the  value  of  client  caused  errors. 

(c)  The  case  error  rate  and  penalty  multiple  shall  be  adjusted  by  ex- 
cluding client  errors  for  the  purpose  of  determining  the  associated  Gener- 
al Fund  expenditures. 

(d)  If  the  Federal  Government  reduces  or  eliminates  any  quality  con- 
trol federal  fiscal  sanction,  federal  withhold  or  federal  disallowance  as- 
sessed a  county  as  a  penalty,  the  Department  shall  reduce  or  eliminate  the 
corresponding  fiscal  penalty  assessment  including  any  associated  Gener- 
al Fund  expenditures  to  liable  counties. 

(e)  The  monitoring  period  shall  be  the  federal  fiscal  year.  Fiscal  penal- 
ties shall  apply  to  the  entire  monitoring  period.  The  first  monitoring  peri- 
od shall  begin  October  1,  1988. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Insfitulions 
Code.  Reference:  Secfion  14016(g),  Welfare  and  Institutions  Code. 

History 

1.  New  section  filed  7-6-83  as  an  emergency;  effective  upon  filing  (Register  83, 
No.  33).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  1 1-3-83. 

2.  Certificate  of  Compliance  transmitted  to  OAL  11-3-83  and  filed  12-6-83 
(Register  83,  No.  50). 

3.  Cortected  Certificate  of  Compliance  as  to  7-6-83  order  filed  1-9-84  (Register 
84,  No.  2). 

4.  Amendment  filed  5-15-92;  operative  6-15-92  (Register  92,  No.  21). 

§  50118.    Application  of  Medi-Cal  Fiscal  Penalties. 

(a)  The  Department  shall  notify  the  county  in  writing  when  it  deter- 
mines that  a  Medi-Cal  fiscal  penalty  will  be  imposed. 

(b)  The  county  may  request  reconsideration  of  the  Medi-Cal  fiscal 
penalty  in  accordance  with  Section  50118.5. 

(c)  When  a  Medi-Cal  fiscal  penalty  is  imposed,  the  amount  of  the  pen- 
alty shall  be  collected  through  direct  repayment. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14016(f)  and  (i).  Welfare  and  Institutions  Code. 

History 

1.  New  section  filed  7-6-83  as  an  emergency;  effective  upon  filing  (Register  83, 
No.  33).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  1 1-3-83. 

2.  Certificate  of  Compliance  transmitted  to  OAL  11-3-83  and  filed  12-6-83 
(Register  83,  No.  50). 

3.  Corrected  Certificate  of  Compliance  as  to  7-6-83  order  filed  1-9-84  (Register 

84,  No.  2). 

4.  Amendment  filed  5-15-92;  operafive  6-15-92  (Register  92,  No.  21). 

§  50118.5.    Reconsideration  of  a  Medi-Cal  Fiscal  Penalty. 

(a)  A  county  may  request  reconsideration  of  a  Medi-Cal  fiscal  penalty 
if  the  county  case  error  rate  is  caused  by  circumstances  outside  the  con- 
trol of  the  county.  Such  circumstances  may  include,  but  are  not  necessari- 
ly limited  to,  the  following: 

(1)  Natural  disasters  which  contribute  significantly  to  the  county  case 
error  rate. 

(2)  Work  stoppages  or  other  work  activity  beyond  the  control  of  the 
county  which  has  a  significant  adverse  impact  on  the  processing  of 
Medi-Cal  eligibility  cases. 

(3)  Failure  by  the  Department  to  meet  the  minimum  sample  of  cases 
specified  in  Section  501 16. 

(4)  Such  other  occurrences  as  determined  by  the  Director. 

(b)  The  county  shall  have  thirty  days  from  the  date  of  the  Department' s 
notice  of  fiscal  penalty  to  file  a  written  request  for  reconsideration  with 
the  Director.  The  request  shall  be  signed  by  the  county  department  Direc- 
tor and  shall  include  a  concise,  detailed  explanation  of  the  basis  for  re- 
questing reconsideration.  The  Director  may,  for  good  cause,  extend  the 
time  to  sixty  days  for  the  county  to  submit  a  request  for  reconsideration. 

(c)  Based  on  all  the  available  written  mateiial,  the  Director  shall  ad- 
dress a  decision  on  reconsideration  to  the  county,  in  writing,  within  sixty 
days  of  receipt  of  the  request. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Insfitulions 
Code.  Reference:  Secfion  14016(f),  Welfare  and  Insfitufions  Code. 


Page  319 


Register  93,  No.  16;  4-16-93 


§  50119 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


History 

1 .  New  section  filed  7-6-83  as  an  emergency;  effective  upon  filing  (Register  83, 
No.  33).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  1 1-3-83. 

2.  Certificate  of  Compliance  transmitted  to  OAL  11-3-83  and  filed  12-6-83 
(Register  83,  No.  50). 

3.  Conected  Certificate  of  Compliance  as  to  7-6-83  order  filed  1-9-84  (Register 

84,  No.  2). 

4.  Amendment  filed  5-15-92;  operafive  6-15-92  (Register  92,  No.  21). 

§  50119.    County  Corrective  Action  Requirements. 

(a)  The  county  shall  correct  a  case  found  in  error  during  the  Depart- 
ment's sample  case  review  within  thirty  days  after  being  notified  of  the 
Department's  final  decision  that  a  case  error  has  occurred. 

(b)  A  county  whose  case  error  rate  is  found  to  be  in  excess  of  fifteen 
percent  shall  within  90  days  of  being  notified  by  the  Department  of  this 
error  rate  provide  a  written  report  to  the  Department  which  shall  describe 
the  steps  the  county  has  taken  or  plans  to  take  to  reduce  or  eliminate  the 
causes  of  error.  The  Department  shall  provide  direction  on  the  form  and 
content  of  the  report  and  shall  be  responsible  for  approving  the  county's 
Corrective  Action  Plan. 

(c)  The  data  collected  on  an  individual  county  during  the  review  con- 
ducted by  the  Department  shall  be  analyzed  by  the  county  to  determine 
causes  of  error.  The  county  shall  utilize  this  information  in  conjunction 
with  other  information  available  to  the  county  to  develop  and  implement 
correction  actions  which  will  reduce  or  eliminate  the  causes  of  error. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14016(h),  Welfare  and  Institufions  Code. 

History 

1.  New  section  filed  7-6-83  as  an  emergency;  effective  upon  filing  (Register  83, 
No.  33).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  1 1-3-83. 

2.  Certificate  of  Compliance  transmitted  to  OAL  11-3-83  and  filed  12-6-83 
(Register  83,  No.  50). 

3.  Corrected  Certificate  of  Compliance  as  to  7-6-83  order  filed  1-9-84  (Register 
84,  No.  2). 

4.  Amendment  filed  5-15-92;  operative  6-15-92  (Register  92,  No.  21). 


Article  3.    County  of  Responsibility  for 
Determination  of  Medi-Cal  Eligibility 

§  50120.    County  of  Responsibility. 

(a)  The  county  of  responsibility  shall  be  the  county  whose  county  de- 
partment is  responsible  for  determining  the  initial  and  continuing  Medi- 
Cal  eligibility  for  a  person  or  family.  The  appropriate  county  of  responsi- 
bility shall  be  determined  in  accordance  with  the  regulations  in  this 
article. 

(b)  Disputes  between  counties  regarding  county  of  responsibility  shall 
be  resolved  by  the  Director. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  10806  and  14016,  Welfare  and  Insfitutions  Code. 

History 

1.  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  501 21 .    Persons  Eligible  Under  SSI/SSP. 

The  county  of  responsibility  for  determining  Medi-Cal  eligibility  for 
persons  eligible  under  AFDC  or  SSI/SSP  shall  be  established  in  accor- 
dance with  the  regulations  of  the  applicable  public  assistance  program. 
NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.1  and  14050.1,  Welfare  and  Institutions  Code. 

History 

1.  Amendment  filed  8-7-78;  effective  thirtieth  day  thereafter  (Register  78,  No. 
32). 

2.  Amendment  filed  7-31-81  as  an  emergency;  effective  upon  filing  (Register  81, 
No.  33).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  11-28-81. 

3.  Certificate  of  Compliance  transmitted  to  OAL  11-6-81  and  filed  1-27-82 
(Register  82,  No.  5). 

4.  Editorial  correction  of  section  heading  filed  7-7-83  (Register  83,  No.  29). 


§  50123.    County  of  Responsibility — Persons  with  a  Family. 

(a)  The  county  of  responsibility  for  determining  Medi-Cal  eligibility 
for  persons  whose  eligibility  as  MN,  MI  or  Other  PA  is  determined  as  part 
of  a  family,  or  based  on  family  income,  shall  be  either  of  the  following: 

(1)  The  county  in  which  the  family's  residence  is  located. 

(2)  The  county  of  physical  presence  if  the  family's  residence  is  un- 
clear. 

(b)  The  county  of  responsibility  for  determining  Medi-Cal  eUgibility 
for  a  family  which  includes  a  person  under  age  21  or,  through  Deceinber 
31,  1982,  an  Ml  person,  living  away  from  the  home  and  who  is  claimed 
by  his/her  parent  as  a  dependent  in  order  to  receive  a  tax  credit  or  deduc- 
tion for  state  or  federal  income  tax  purposes  shall  be  the  county  in  which 
the  claiming  parent  lives  as  determined  in  accordance  with  (a). 

(c)  The  county  of  responsibility  for  determining  Medi-Cal  eligibility 
for  a  person  who  is  claimed  by  his/her  parent  as  a  dependent  or  as  a  de- 
duction for  tax  purposes  and  whose  parent  lives  out  of  state  shall  be  the 
county  in  which  such  person  resides  as  determined  in  accordance  with 
(a). 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code;  Section  57(c),  Chapter  328,  Statutes  of  1982;  and  Section  87(c),  Chapter 
1594,  Statutes  of  1982.  Reference:  Sections  1 1050,  14005.4,  14005.7,  14008  and 
14016(a)  and  (c),  Welfare  and  Institutions  Code. 

History 

1.  New  subsecfions  (b)  and  (c)  filed  10-1-82  as  an  emergency;  effecfive  upon  fil- 
ing (Register  82,  No.  40).  A  Ceitificate  of  Compliance  must  be  transmitted  to 
OAL  within  120  days  or  emergency  language  will  be  repealed  on  1-29-83. 

2.  Certificate  of  Compliance  including  editorial  cortection  of  NOTE  transmitted 
to  OAL  1-28-83  and  filed  2-28-83  (Register  83,  No.  10). 

3.  Editorial  con-ection  of  NOTE  filed  4-12-83  (Register  83,  No.  16). 

§  50125.    County  of  Responsibility — Persons  with  No 
Family. 

(a)  The  county  of  responsibility  for  determining  Medi-Cal  eligibility 
for  persons  whose  eligibihty  as  MN,  MI  or  Other  PA  is  not  determined 
as  part  of  a  family,  nor  based  on  family  income,  shall  be: 

(1)  The  placing  county  for: 

(A)  Persons  placed  by  a  county  agency  in  a  private  or  county-adminis- 
tered facility  in  order  to  receive  long-term  care. 

(B)  Children  placed  by  a  county  agency  in  foster  or  adoptive  care  un- 
der Aid  Codes  04,  43,  44,  45,  46  and  47. 

(2)  The  county  in  which  the  person's  home  is  located,  if  the  person  is 
temporarily  absent  from  the  home  as  specified  in  Section  50071(a)(2). 

(3)  The  county  in  which  the  person  is  living  in  all  other  situations. 
NOTE:  Authority  cited:  Sections  10725, 14006.1  and  14124.5,  Welfare  and  Insti- 
tutions Code.  Reference:  Secfions  11050,  14005.4,  14006,  14008  and  14016(a) 
and  (c).  Welfare  and  Institutions  Code. 

History 

1.  Amendment  of  subsection  (a)(1)(B)  filed  12-15-77;  effecfive  thirtieth  day 
thereafter  (Register  77,  No.  51). 

2.  Amendment  of  subsections  (a)(2)  and  (a)(3)  filed  12-2-85  as  ain  emergency;  ef- 
fective upon  filing  (Register  85,  No.  50).  A  Certificate  of  Compliance  must  be 
transmitted  to  OAL  within  1 20  days  or  emergency  language  will  be  repealed  on 
4-1-86. 

3.  Certificate  of  Compliance  transinitted  to  OAL  3-31-86  and  filed  4-30-86 
(Register  86,  No.  18). 

§  50126.    County  of  Responsibility — Persons  Eligible  Under 
Special  Programs. 

(a)  The  county  of  responsibility  for  determining  Medi-Cal  eligibility 
for  persons  eligible  under  the  Cuban  Refugee,  Indochine&e  Refugee,  and 
Medi-Cal  Dialysis  Programs  shall  be: 

(1)  The  county  in  which  the  person's  residence  is  located. 

(2)  The  county  of  physical  presence  if  the  person's  residence  is  un- 
clear. 

(b)  The  county  of  responsibility  for  determining  Medi-Cal  eligibihty 
for  persons  eligible  under  the  MC  800  Program  shall  be  the  county  which 
owns  the  medical  facility,  or  which  has  a  contract  with  the  hospital, 
where  health  services  are  received. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Secfion  14016,  Welfare  and  Institufions  Code. 


Page  320 


Register  93,  No.  16;  4-16-93 


Title  22 


Health  Care  Services 


§  50136 


History 

) .  New  section  filed  3-7-80;  effective  thirtieth  day  thereafter  (Register  80,  No.  9). 

§  50127.    Persons  with  a  Guardian. 

(a)  The  county  of  responsibility  for  persons  with  a  county  public 
guardian  shall  be  the  county  in  which  the  public  guardian  is  located  ex- 
cept that  if  the  person  is  physically  present  in  another  county  and  the  new 
county  will  accept  a  transfer  of  guardianship,  the  new  county  shall  be  the 
county  of  responsibility. 

(b)  The  county  of  responsibility  for  persons  with  a  private  guardian  or 
persons  with  a  guardian  employed  by  the  state  shall  be  estabHshed  as  if 
there  were  no  guardian  in  accordance  with  Sections  50121,  50123  and 
50129  through  50134,  provided  the  ward  is  a  resident  of  the  State. 
NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  11050,  14001  and  14016,  Welfare  and  Institutions 
Code. 

History 

1 .  Amendment  filed  12-15-77;  effective  thirtieth  day  thereafter  (Register  77,  No. 
51). 

2.  Editorial  conection  filed  7-7-83  (Register  83,  No.  29). 

§  50129.    County  of  Responsibility — Persons  Placed  In 
State  Hospitals  by  County  Mental  Health 
Agencies  or  Regional  Centers  for  the 
Oevelopmentally  Disabled. 

Notwithstanding  the  requirements  of  any  other  section  in  this  article, 
the  county  of  responsibility  for  determining  Medi-Cal  eligibility  for  per- 
sons placed  in  state  hospitals  after  screening  and  referral  by  a  county 
mental  health  agency  or  a  regional  center  for  the  Developmentally  Dis- 
abled shall  be  the  county  in  which  the  state  hospital  is  located,  unless  the 
person's  eligibility  is  determined  as  part  of  a  family  or  based  on  family 
income.  In  this  case  the  county  of  responsibility  shall  be  determined  in 
accordance  with  Section  50123. 

§  50131 .    Placement  in  Long-Term  Care  After  Release  from 
a  State  Hospital. 

(a)  Notwithstanding  the  requirements  of  any  other  section  in  this  ar- 
ticle, the  county  of  responsibility  for  determining  Medi-Cal  eligibility 
for  persons  released  from  a  state  hospital  and  placed  in  a  long-term  care 
facility  shall  be  the  county  in  which  the  long-term  care  facility  is  located, 
with  the  following  exceptions: 

(1)  If  the  person  has  a  public  guardian  or  conservator  in  the  original 
county  of  placement  into  the  state  hospital,  then  that  county  shall  remain 
the  county  of  responsibility,  unless  the  county  in  which  the  long-term 
care  facility  is  located  agrees  to  accept  guardianship  or  conservatorship 
of  the  person. 

(2)  If  the  person' s  eligibility  is  determined  as  part  of  a  family  or  based 
upon  family  income,  then  the  county  of  responsibility  shall  be  deter- 
mined in  accordance  with  Section  50123. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  11050,  14001  and  14016,  Welfare  and  Institutions 
Code. 

History 

1 .  Amendment  filed  3-7-80;  effective  thirtieth  day  thereafter  (Register  80,  No.  9). 

2.  Editorial  correction  filed  7-7-83  (Register  83,  No.  29). 

§  50133.    County  of  Responsibility — Deceased  Persons. 

The  county  of  responsibility  for  determining  Medi-Cal  eligibility  for 
persons  who  are  deceased  shall  be  the  county  which  would  have  been  the 
county  of  responsibility  at  the  time  of  the  person's  death. 

§  50134.    County  of  Responsibility — Persons  Absent  from 
the  State. 

The  county  of  responsibility  for  determining  Medi-Cal  eligibility  for 
persons  who  are  absent  from  the  State  and  retain  California  residence,  in 
accordance  with  Article  7  of  these  regulations,  shall  be  the  county  which 
would  have  been  the  county  of  responsibility  prior  to  the  person's  ab- 
sence from  the  State. 


§  50135.    Application  Made  in  County  Other  Than  County  of 
Responsibility. 

(a)  The  county  in  which  a  person  applies  for  Medi-Cal  shall  accept  the 
application  and  a  Statement  of  Facts  from  such  person  or  family  on  behalf 
of  the  county  of  responsibility.  If  a  Statement  of  Facts  cannot  be  obtained, 
the  county  accepting  the  application  shall  provide  information  to  the 
county  of  responsibility  for  the  latter  county  to  locate  the  applicant. 

(b)  The  information  described  above  shall  be  forwarded  to  the  county 
of  responsibility  not  later  than  15  days  from  the  date  of  application. 

(c)  The  county  in  which  a  person  applies  may  with  the  consent  of  the 
applicant  or  beneficiary,  choose  to  become  the  county  of  responsibility 
for  determining  initial  eligibility  and  initiating  an  intercounty  transfer. 
NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  11050,  14001  and  14016,  Welfare  and  Institutions 
Code. 

History 
1.  Editorial  coirection  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 


§  50136.     Intercounty  Transfer  Procedure. 

(a)  An  intercounty  transfer  shall  be  initiated  if  persons  or  families  re- 
ceiving Medi-Cal-only  become  the  responsibility  of  a  new  county.  The 
transfer  shall  be  accomplished  in  accordance  with  the  following  proce- 
dure, as  modified  by  Section  50138. 

(1 )  The  county  department  initiating  the  transfer  shall  inform  the  bene- 
ficiary in  writing  of  his/her  responsibility  to  apply  for  a  redetermination 
of  ehgibility  in  the  new  county  of  residence  and,  within  7  calendar  days 
of  the  date  the  county  department  learns  of  the  change  in  county  of  re- 
sponsibility, send  the  following  to  the  county  department  in  the  new 
county  of  responsibility: 

(A)  Two  copies  of  the  Notification  of  Transfer,  Form  ABCDM  21 5, 
with  Section  A  completed  indicating  the  date  of  discontinuance  deter- 
mined in  accordance  with  Section  50137. 

(B)  One  copy  of  the  most  recently  completed  of  each  of  the  following 
forms  with  the  Notification  of  Transfer,  Form  ABCDM  215,  or  within 
one  week  after  this  form  is  sent: 

1.  Application  for  PubHc  Social  Services,  CA  1. 
1.  Statement  of  Fact,  MC  210,  MC  250  or  CA  2. 

3.  Share  of  Cost  Determination — MN  and  MI  Person,  MC  176M. 

4.  Allocation/Special  Deduction  Worksheet,  MC  176W,  if  any. 

5.  Property  Worksheet,  MC  176P,  if  any. 

6.  Rights  of  Persons  Requesting  Medi-Cal,  MC  216,  if  any. 

7.  Medi-Cal  Responsibilities  Checklist,  MC  217,  if  any. 

8.  Verification  of  disability,  if  any. 

9.  Notification  of  Action,  Utilization  of  Property,  Form  MC  239U,  if 
the  person  or  family  is  within  a  six-month  utilization  period  at  the  time 
of  transfer. 

(C)  The  amount,  if  any,  of  a  remaining  adjustment  for  decreases  in  in- 
come pursuant  to  Section  50653.3. 

(D)  Other  information  that  the  initiating  county  considers  important  in 
order  for  the  new  county  of  responsibility  to  determine  eligibility. 

(2)  The  initiating  county,  if  the  person  or  family  becomes  the  responsi- 
bility of  a  third  county  during  the  transfer  process,  shall: 

(A)  Notify  the  former  new  county  department  that  the  transfer  is  can- 
celled. 

(B)  Request  the  former  new  county  department  to  forward  to  the 
county  department  of  the  current  new  county  of  responsibility  all  infor- 
mation and  documents  supplied  by  the  initiating  county  and  any  addi- 
tional information  secured  by  the  former  new  county. 

(C)  Send  to  the  current  new  county  department  two  copies  of  the  Noti- 
fication of  Transfer,  Form  ABCDM  215,  with  Section  A  completed  indi- 
cating the  date  of  discontinuance  determined  in  accordance  with  Section 
50137. 

(3)  The  county  department  in  the  new  county  of  responsibility  shall: 


Page  321 


Register  2000,  No.  38;  9-22-2000 


§  50137 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


(A)  Perform  a  redetermination  of  eligibility  if  the  conditions  of  Sec- 
tion 50136  (a)(i)  are  met. 

(B)  Return  to  the  initiating  county  department  one  copy  of  the  Notifi- 
cation of  Transfer  form,  Form  ABCDM  215,  within  30  days  of  receipt  of 
the  form.  Section  B  shall  be  completed,  indicating  acceptance  or  refusal 
of  the  transfer,  and  the  effective  date  of  eligibility,  if  eligibility  is  ap- 
proved in  the  new  county. 

(C)  Send  a  Notice  of  Action  to  the  person  or  family,  if  their  eligibihty 
is  approved.  A  Notice  of  Action  must  also  be  sent  to  the  person  or  family 
if  eligibility  is  discontinued  for  failure  to  apply  for  a  redetermination  or 
if  the  person  or  family  is  no  longer  eligible.  Such  action  shall  be  effective 
as  established  in  accordance  with  Section  50137. 

(4)  If  the  Notification  of  Transfer  form  has  not  been  returned  within 
30  days,  the  initiating  county  shall  contact  the  new  county  to  assure  that 
continuous  Medi-Cal  coverage  will  be  provided  to  the  extent  that  eligi- 
bility exists. 

NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  1 1053  and  14016,  Welfare  and  Institutions  Code. 

History 

1.  Amendment  of  subsection  (a)(1)(B)  filed  12-15-77;  effective  thirtieth  day 
thereafter  (Register  77,  No.  51). 

2.  Amendment  filed  8-8-80;  effective  thirtieth  day  thereafter  (Register  80,  No. 
32). 

3.  Editorial  correction  filed  7-7-83  (Register  83,  No.  29). 

4.  Amendment  filed  4-17-86:  effective  thirtieth  day  thereafter  (Register  86,  No. 
16). 

5.  Change  without  regulatory  effect  of  subsection  (a)(1)(C)  (Register  87,  No.  11). 

§  50137.    Intercounty  Transfer — Effective  Date  of 
Discontinuance/Eligibility. 

(a)  In  a  change  in  county  of  responsibihty,  the  effective  date  of  discon- 
tinuance as  determined  by  the  initiating  county  department  shall  be  the 
last  day  of  the  month  in  which  the  30th  day  after  notification  to  the  new 
county  of  the  change  in  county  of  responsibihty  occurs  except  that: 

(1)  If  the  initiating  county  department  determines  the  person  or  family 
is  no  longer  eligible,  the  last  day  of  the  month  in  which  the  determination 
of  ineligibility  is  made,  provided  a  10-day  notice  is  given  or  is  waived. 
Otherwise,  discontinuance  is  effective  on  the  last  day  of  the  month  in 
which  the  1 0-day  notice  is  given. 

(2)  If  the  person  or  family  is  receiving  Medi-Cal  under  either  the  Four 
Month  or  Nine  Month  Continuing  Eligibility  categories,  the  last  day  of 
the  final  month  in  which  four  month  or  nine  month  continuing  eligibility 
exists. 

(b)  If  the  county  department  in  the  new  county  of  responsibility  deter- 
mined that  a  person  or  family  is  eligible  for  Medi-Cal,  the  effective  date 
of  eligibility  shall  be  the  first  day  of  the  month  following  the  month  in 
which  the  initiating  county  department  discontinues  eligibility. 

(c)  Counties  involved  in  an  intercounty  transfer  may,  by  mutual  agree- 
ment, establish  a  different  effective  date  of  discontinuance,  if  the  initiat- 
ing county  department  can  suppress  card  issuance  for  the  following 
month. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  Section  1 33.5,  Chapter  1 02,  Statutes  of  1 98 1 ;  and  Section  14,  Chapter  1 447, 
Statutes  of  1984.  Reference:  Sections  10740, 1 1053, 14005.8,  14005.9, 14016(a) 
and  14100.1,  Welfare  and  Institutions  Code. 

History 

1 .  Amendment  of  subsection  (a)(2)  filed  4-15-85  as  an  emergency;  effective  upon 
filing  (Register  85,  No.  16).  A  Certificate  of  Compliance  must  be  transmitted 
to  OAL  within  120  days  or  emergency  language  will  be  repealed  on  8-13-85. 
For  prior  history,  see  Register  84,  No.  24. 

2.  Certificate  of  Compliance  as  to  4-15-85  order  transmitted  to  OAL  8-13-85  and 
filed  9-18-85  (Register  85,  No.  38). 

§  501 38.    Intercounty  Transfer — Blindness  or  Disability 
Determination  Pending. 

(a)  In  a  change  of  county  of  responsibility  for  persons  or  families  who 
have  an  application  pending  for  either  the  SSI/SSP  or  MN  programs  on 
the  basis  of  blindness  or  disability,  the  responsibility  shall  be  transferred 
to  the  new  county  in  accordance  with  the  following: 

(1)  If  the  person  or  family  is  eligible  for  Medi-Cal  at  the  time  the 
county  of  responsibility  changes,  responsibility  shall  be  transferred  in  ac- 
cordance with  Sections  50136  and  50137. 


(2)  The  pending  determination  of  blindness  or  disabihty  shall  be  re- 
tained by  the  initiating  county  department  until  the  blindness  or  disability 
determination  is  received.  The  initiating  county  department  shall  for- 
ward the  blindness  or  disability  determination,  along  with  the  documents 
specified  in  Section  501 36  (a)  (1)  (B),  within  14  calendar  days  of  the  date 
the  determination  was  received. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  11053.  14001  and  14016,  Welfare  and  Institutions 
Code. 

History 
1.  Editorial  con-ection  adding  NOTE  filed  7-7-83  (Register  83.  No.  29). 


Article  4.     Beneficiary  Application  Process 

§  50141.     Application  Process — General. 

The  county  department  shall  receive  and  act  upon  all  applications, 
reapplications,  requests  for  restoration  and  redeterminations  without 
delay  and  in  accordance  with  the  provisions  of  this  article. 

History 

1.  Change  without  regulatory  effect  amending  article  4  heading  filed  9-19-2000 
pursuant  to  section  1 00,  title  1 ,  California  Code  of  Regulations  (Register  2000, 
No.  38). 

§50142.    Screening. 

(a)  County  departments  that  have  established  a  procedure  for  screen- 
ing potential  applicants  prior  to  application  shall: 

(1)  Determine  the  Medi-Cal  program  under  which  the  person  or  fami- 
ly should  be  processed. 

(2)  Provide  information  regarding  Medi-Cal  eligibility  requirements 
to  all  persons  being  screened. 

(3)  Inform  each  person  being  screened  of  that  person' s  rights  under  the 
Medi-Cal  program,  even  if  it  appears  that  the  person  is  ineUgible.  Rights 
of  Persons  Requesting  Medi-Cal,  MC  216,  shall  be  explained  to,  and 
signed  by,  the  person  being  screened. 

(A)  The  original  shall  be  retained  by  the  county  department.  If  the  per- 
son being  screened  does  not  apply  for  Medi-Cal,  the  form  shall  be  re- 
tained for  at  least  90  days. 

(B)  A  copy  shall  be  given  to  the  person  being  screened. 

§  50143.    Persons  Who  May  File  an  Application  for 
Medi-Cal. 

(a)  Any  person  who  wishes  to  receive  Medi-Cal  may  file  an  applica- 
tion. If  the  appUcant  for  any  reason  is  unable  to  apply  on  his  own  behalf, 
or  is  deceased,  any  of  the  following  persons  may  file  the  application  for 
the  applicant. 

(1)  The  applicant's  guardian  or  conservator  or  executor. 

(2)  A  person  who  knows  of  the  applicant's  need  to  apply. 

(3)  A  public  agency  representative. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  11050,  14001,  14005.4,  14005.7,  14016.1  and 
14016.2,  Welfare  and  Institutions  Code. 

History 

1.  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

2.  Amendment  of  subsection  (a)  filed  7-9-87;  operative  8-8-87  (Register  87,  No. 
30). 

§  50145.    Medi-Cal  Application  for  Persons  Applying  for  a 
Cash  Grant  or  In-Home  Supportive  Services. 

(a)  A  person  or  family  applying  and  approved  for  any  public  assistance 
program  as  specified  in  Section  50227  or  In-Home  Supportive  Services 
shall  not  be  required  to  submit  a  separate  application  for  Medi-Cal. 
Medi-Cal  eligibility  is  established  automatically. 

(b)  A  person  or  family  specified  in  (a)  may  also  apply  for  retroactive 
Medi-Cal  in  accordance  with  Section  50148. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5.  Welfare  and  Institutions 
Code.  Reference:  Sections  12305,  12305.5,  14005.1,  14019,  14050.1  and 
14051.5,  Welfare  and  Institutions  Code. 

History 
1 .  Amendment  filed  8-7-78;  effective  thirtieth  day  thereafter  (Register  78,  No. 
32). 


Page  322 


Register  2000,  No.  38;  9-22-2000 


Title  22 


Health  Care  Services 


§  50148 


2.  Amendment  filed  7-31-8 1  as  an  emergency;  effective  upon  filing  (Register  8 1 , 
No.  33).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  1  i -28-81. 

3.  Certificate  of  Compliance  transmitted  to  OAL  11-6-81  and  filed  1-27-82 
(Register  82,  No.  5). 

4.  Amendment  filed  7-9-87;  operative  8-8-87  (Register  87,  No.  30). 

§  50146.     Medi-Cal  Application  for  Persons  Applying  for 
In-Home  Supportive  Services. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5.  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.1  and  12305,  Welfare  and  Insfitutions  Code. 

History 

1.  Amendment  filed  8-7-78;  effective  thirtieth  day  thereafter  (Register  78,  No. 
32). 

2.  Repealer  filed  7-9-87;  operative  8-8-87  (Register  87,  No.  30). 

§  50147.     Application  for  Medi-Cal  Only. 

(a)  A  person  or  family  applying  for  Medi-CaJ  only  shall  submit  a  com- 
pleted application  form  to  the  county  department. 

(b)  The  county  department  shall,  within  30  days  of  receipt  of  a  referral 
from  the  Department  pursuant  to  50183.5,  contact  an  ABD  person  in  a 
long-term  care  facility  and  assist  the  ABD  person  with  the  completion 
of  an  application  form  for  Medi-Cal-only. 

(1)  An  application  for  Medi-Cal-only  shall  be  completed  when: 

(A)  The  ABD  person  has  been  in  long-term  care  for  more  than  the 
month  of  admission  and  is  expected  to  remain  in  the  facility  for  at  least 
30  days. 

(B)  The  ABD  person  has  nonexempt  monthly  gross  income  in  excess 
of  $44.90. 

(2)  The  county  department  shall  advise  the  Department  immediately 
that  an  inappropriate  referral  has  been  received  when  the  conditions  in 
(1)  do  not  exist. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  1 1004,  and  14016,  Welfare  and  Institutions  Code. 

History 
I.  Amendment  filed  4-13-81 ;  effective  thirtieth  day  thereafter  (Register  81,  No. 
16). 

§  501 47.1 .     Child  Applying  for  Medi-Cal. 

(a)  A  child  may  apply  for  Medi-Cal  without  parental  contact  in  order 
to  receive  minor  consent  services. 

(b)  A  child  applying  on  the  basis  of  a  need  for  minor  consent  services 
other  than  mental  health  care  shall  submit  to  the  county  welfare  depart- 
ment a  completed  and  signed  form  Request  for  Eligibility  for  Limited 
Services  indicating  the  need  for  services  related  to  one  or  more  of  these 
needs. 

(c)  A  child  applying  for  Medi-Cal  solely  on  the  basis  of  a  need  for 
mental  health  care  shall  submit  to  the  county  welfare  department  a  state- 
ment from  a  mental  health  professional:  licensed  marriage,  family  and 
child  counselor;  licensed  educational  psychologist;  credentialed  school 
psychologist;  clinical  psychologist;  or  a  licensed  psychologist  which 
states  that  the  child  needs  mental  health  treatment  or  counseling  and 
meets  both  of  the  following  conditions: 

(1)  Is  mature  enough  to  participate  intelligently  in  the  mental  health 
treatment  or  counseling  on  an  outpatient  basis. 

(2)  Is  one  of  the  following: 

(A)  In  danger  of  causing  serious  physical  or  mental  harm  to  self  or  oth- 
ers without  mental  health  treatment  or  counseling. 

(B)  The  alleged  victim  of  incest  or  child  abuse. 

(d)  The  county  department  shall  process  the  applications  of  children 
applying  under  (b)  and  (c)  in  accordance  with  the  following: 

( 1 )  If  a  child  refuses  to  complete  or  sign  the  form  or  provide  a  statement 
of  need  for  mental  health  care  the  child's  application  shall  be  denied. 

(2)  If  a  child  is  not  competent  to  complete  or  sign  the  form,  the  person 
completing  the  Statement  of  Facts  in  accordance  with  Section 
50163(a)(2)  and  (3)  may  sign  the  form  on  the  child's  behalf. 

(3)  After  submission  of  the  completed  and  signed  form  or  statement 
of  need  for  mental  health  care,  the  county  department  shall: 

(A)  Deny  the  application  if  a  child  is  under  12  years  of  age  and  apply- 
ing for  services  related  to  drug  abuse,  alcohol  abuse,  venereal  disease  or 
a  sexually  transmitted  disease  or  for  mental  health  care. 


(B)  Issue  POE  labels  under  the  child's  existing  Medi-Cal  status  if  the 
child  is  currently  included  in  a  public  assistance  case  or  an  MFBU  which 
has  no  share  of  cost  and  is  not  enrolled  in  a  PHP  or  PCCM  plan.  The 
child's  separate  application  shall  be  denied. 

(C)  Deny  the  application  if  the  child  is  currently  eligible  for  Medi-Cal 
and  enrolled  in  a  PHP  or  PCCM  plan  and  refer  the  child  to  the  PHP  or 
PCCM  plan  for  care. 

(D)  Process  the  application  and  determine  eligibility  if  the  child  is  one 
of  the  following: 

1.  Currently  included  in  an  MFBU  which  has  a  share  of  cost. 

2.  Part  of  a  family  not  currently  receiving  Medi-Cal. 

3.  Excluded  from  an  MFBU. 

4.  An  ineligible  member  of  an  MFBU. 

(E)  If  the  child  is  an  unmarried  minor  parent,  he/she  shall  be  included 
in  the  MFBU  with  his/her  child  for  minor  consent  services  only. 

(e)  When  a  child  is  not  living  with  the  child's  parents  and  county  de- 
partment determines  that  no  person  or  agency  accepts  legal  responsibility 
for  the  child,  the  county  department  shall  process  the  child's  application 
and  determine  his  or  her  eligibility  as  an  adult  if  the  child  appears  to  be 
competent. 

(f)  The  parents  of  a  child  applying  in  accordance  with  (b)  or  (c)  shall 
neither  be  contacted  regarding  the  child's  application  nor  informed  that 
the  application  has  occurred. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.1.  14005.4,  14005.7,  14008,  14008.5,  14010, 
14011, 14017, 14018,  and  14088.3,  Welfare  and  Institutions  Code;  Sections  25.6, 
25.9,  34.5,  34.7,  34.9  and  34.10,  Civil  Code, 

History 

1.  New  section  filed  10-31-78  as  an  emergency,  designated  effective  11-1-78 
(Register  78,  No.  44). 

2.  Certificate  of  Compliance  filed  2-6-79  (Register  79,  No.  15). 

3.  New  subsection  (c)  filed  4-9-79;  effecfive  thirtieth  day  thereafter  (Register  79, 
No.  15). 

4.  Amendment  filed  4-28-82;  effective  thirtieth  day  thereafter  (Register  82,  No. 
18). 

5.  Editorial  correcfion  filed  7-7-83  (Register  83,  No.  29). 

6.  Amendment  of  subsections  (c)  and  (d)  filed  3-9-90  as  an  emergency;  operative 
3-9-90  (Register  90,  No.  12).  A  Certificate  of  Compliance  must  be  transmitted 
to  OAL  within  1 20  days  or  emergency  language  will  be  repealed  on  7-9-90. 

7.  Amendment  refiled  7-9-90  as  an  emergency;  operative  7-9-90  (Register  90, 
No.  35).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  by  operafion  of  law  on  1 1  -6-90. 

8.  Request  to  readopt  amendment  on  an  emergency  basis  pursuant  to  Government 
Code  section  11346.1  granted  and  filed  11-6-90  as  an  emergency;  operative 
1 1-6-90  (Register  91,  No.  6).  A  Certificate  of  Compliance  must  be  transmitted 
to  OAL  within  120  days  or  emergency  language  will  be  repealed  on  3-6-91 . 

9.  Certificate  of  Compliance  as  to  1 1-6-90  order  transmitted  to  OAL  2-22-91; 
disapproved  by  OAL  on  3-25-91  (Register  91,  No.  18). 

10.  Amendment  of  subsections  (c)  and  (d)  filed  3-25-91  as  an  emergency;  opera- 
tive 3-25-91  (Register  91,  No.  18).  A  Certificate  of  Compliance  must  be  trans- 
mitted to  OAL  by  7-23-91  or  emergency  language  will  be  repealed  by  opera- 
tion of  law  on  the  following  day. 

1 1 .  Certificate  of  Compliance  as  to  3-25-91  order  transmitted  to  OAL  7-19-91 
and  filed  8-19-91  (Register  92,  No.  1). 

§  50148.    Application  for  Retroactive  Medi-Cal. 

(a)  A  person  or  family  applying  for  retroactive  Medi-Cal  shall: 

(1)  Submit  a  completed  application  form  to  the  county  department,  if 
the  application  is  for  retroactive  coverage  only. 

(2)  Request  retroactive  coverage  in  one  of  the  following  ways  if  the 
request  for  retroactive  Medi-Cal  is  made  in  conjunction  with,  or  after,  an 
application  for  public  assistance  or  Medi-Cal: 

(A)  On  the  application  form. 

(B)  On  the  Statement  of  Facts. 

(C)  By  submitting  a  written  request. 

(b)  An  application  for  retroactive  coverage  pursuant  to  (a)(2)  must  be 
submitted  within  one  year  of  the  month  for  which  retroactive  coverage 
is  requested. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Insfitutions 
Code.  Reference:  Sections  11050, 14001, 14019  and  14019.6,  Welfare  and  Institu- 
tions Code. 

History 

1.  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

2.  New  subsecfion  (b)  filed  7-9-87;  operafive  8-8-87  (Register  87,  No.  30). 


Page  323 


Register  96,  No.  34;  8-23-96 


§  50149 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


§50149.     Application  Form. 

(a)  An  application  for  Public  Social  Services  shall  be  used  as  the  appli- 
cation form  for  all  Medi-Cal  applications. 

(b)  The  original  of  the  completed  form  shall  be  placed  in  the  case  file. 

(c)  A  copy  of  the  completed  form  shall  be  given  to  the  applicant  at  the 
time  of  application. 

(d)  Only  one  person's  signature  shall  be  required  on  the  application  or 
any  other  forms  necessary  to  complete  the  eligibility  determination. 

(e)  A  new  appUcation  form  shall  not  be  required  for: 

(1)  Requests  for  restoration  of  aid. 

(2)  Interprogram  transfers. 

(3)  Interprogram  status  changes. 

(4)  Request  to  add  a  family  member  to  the  Medi-Cal  case. 

(5)  Redeterminations. 

(6)  Infants  meeting  the  criteria  under  the  Continued  Eligibility  Pro- 
gram as  described  in  Section  50262.3. 

NOTE:  Authority  cited:  Sections  10725, 1 4016. 10  and  141 24.5,  Welfare  and  Insti- 
tutions Code.  Reference:  Sections  1 1050,  1 1053  and  14001,  Welfare  and  Institu- 
tions Code. 

HtSTORY 

1.  Editorial  correction  filed  7-7-83  (Register  83,  No.  29). 

2.  New  subsection  (e)(6)  and  amendment  of  Note  filed  4-27-94  as  an  emergency; 
operative  4-27-94  (Register  94,  No.  17).  A  Certificate  of  Compliance  must  be 
transmitted  to  OAL  by  8-25-94  or  emergency  language  will  be  repealed  by  op- 
eration of  law  on  the  following  day. 

3.  Certificate  of  Compliance  as  to  4-27-94  order  transmitted  to  OAL  8-24-94  and 
filed  9-29-94  (Register  94,  No.  39). 

§  501 51 .    Date  of  the  Application. 

(a)  The  date  of  application  for  a  person  or  family  applying  for  Medi- 
Cal  shall  be  the  date  the  completed  application  form  is  received  by  the 
county  department. 

(b)  The  date  of  application  for  a  person  or  family  applying  for  Medi- 
Cal  in  a  county  other  than  the  county  of  responsibility  shall  be  the  date 
the  completed  application  form  is  received  by  the  county  department  in 
which  the  application  is  being  made. 

§  50153.     Medi-Cal  Application — Process  for  All  Programs. 

(a)  An  application  for  Medi-Cal  under  any  program  other  than  SSI/ 
SSP  shall  be  an  application  for  Medi-Cal  under  all  such  programs  for 
which  the  person  or  family  may  be  eligible. 

(b)  When  taking  an  application,  the  county  department  shall: 

(1)  Determine  the  program  under  which  the  person  or  family  may  be 
eligible. 

(2)  Process  the  application  under  the  appropriate  program.  Applica- 
tions by  persons  who  appear  to  be  eligible  for  SSI/SSP  shall  be  processed 
in  accordance  with  (3).  Applications  by  persons  who  appear  to  be  eligible 
for  AFDC  hall  be  processed  in  accordance  with  (4). 

(3)  Refer  persons  who  may  be  eligible  for  SSI/SSP,  and  who  do  not 
refuse  to  apply  for  that  program,  to  the  Social  Security  Administration  for 
a  determination  of  SSI/SSP  eligibility. 

(A)  The  referral  shall  be  documented  in  the  case  file. 

(B)  Pending  the  SSI/SSP  determination,  the  county  department  shall 
determine  eligibility  under  any  other  program  for  which  the  person  may 
be  eligible. 

(4)  Applicants  who  appear  to  be  eligible  for  an  AFDC  cash  grant  shall 
be  advised  of  their  potential  eligibility  and  the  application  shall  be  pro- 
cessed under  the  AFDC  cash  grant  program  if  the  applicant  so  desires. 
The  fact  that  the  applicant  was  advised  of  potential  AFDC  cash  grant  eli- 
gibility shall  be  documented  in  the  case  file. 

(c)  A  person  or  family  may  choose  to  have  their  application  processed 
under  any  program  for  which  they  are  eligible  even  if  such  program  is  not 
the  most  advantageous. 

§  50155.    Withdrawal  of  Application — Request  for 
Discontinuance. 

(a)  An  applicant  or  beneficiary  may  withdraw  an  application  for  or  re- 
quest discontinuance  from  Medi-Cal  by  any  of  the  following  methods: 


(1)  Completion  of  a  Request  for  Withdrawal  of  Application  or  Discon- 
tinuance of  Eligibility  form. 

(A)  The  original  shall  be  placed  in  the  case  file. 

(B)  A  copy  shall  be  given  to  the  applicant. 

(2)  Submission  of  a  signed  request  for  withdrawal  or  discontinuance. 
The  request  for  withdrawal  or  discontinuance  shall  be  placed  in  the  case 
ftle. 

(3)  Failing  to  respond  to  a  Notice  of  Action  which  requests  that  the 
beneficiary  contact  the  county  to  indicate  a  desire  to  continue  eligibility. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  1 1050  and  14001,  Welfare  and  Institutions  Code. 

History 
1.  Editorial  correction  filed  7-7-83  (Register  83,  No.  29). 

§  50157.    Face-to-Face  Interview. 

(a)  A  face-to-face  interview  with  the  applicant,  or  the  person  complet- 
ing the  Statement  of  Facts,  is  required  only  at  the  time  of  application, 
reapplication,  restoration  or  as  specified  in  (d).  The  interview  shall  be 
completed  within  30  days  of  the  date  of  application,  reapplication  or  res- 
toration. 

(b)  A  face-to-face  interview  shall  not  be  required  at  time  of  applica- 
tion, reapplication  or  restoration  for  persons  who  have  a  government  rep- 
resentative, such  as  a  public  guardian,  acting  on  their  behalf. 

(c)  A  face-to-face  interview  at  restoration  shall  not  be  required,  for 
beneficiaries  who  have  been  notified  that  eligibility  will  be  discontinued, 
if  the  request  for  restoration  is  received  before  the  effective  date  of  dis- 
continuance. 

(d)  A  face-to-face  interview  shall  be  required  at  redetermination  of 
eligibility  for  persons  or  families  indicated  in  this  paragraph.  The  inter- 
view shall  be  completed  within  the  month  in  which  redetermination  is  re- 
quired. A  face-to-face  interview  shall  be  completed  once  a  year  at  time 
of  redetermination  for  all  MFBUs  which  contain  at  least  one  AFDC-MN 
or  MI  member,  except  for  MFBUs  consisting  of  any  of  the  following: 

(1)  Persons  who  receive  Medi-Cal  through  the  Aid  for  Adoption  of 
Children  program. 

(2)  Persons  who  have  a  government  representative,  such  as  a  public 
guardian,  acting  on  their  behalf. 

(3)  MI  children  who  are  not  living  with  a  parent  or  relative  and  for 
whom  a  public  agency  is  assuming  financial  responsibility  in  whole  or 
in  part. 

(e)  The  face-to-face  interview  shall  be  conducted  by  a  representative 
of  the  county  department  unless,  for  good  reason,  a  direct  interview  be- 
tween the  county  department  and  the  applicant  or  the  person  completing 
the  Statement  of  Facts  is  not  possible.  In  such  a  situation,  the  interview 
may  be  conducted  by  another  public  agency  acting  on  behalf  of  the 
county  department. 

(f)  The  representative  of  the  agency  conducting  the  interview  shall 
verbally  advise  the  applicant,  or  the  person  completing  the  Statement  of 
Facts,  in  detail  of  the: 

(1)  Eligibihty  requirements. 

(2)  Medi-Cal  benefits  available  under  the  Medi-Cal  program. 

(3)  Confidential  nature  of  information  received,  including  the  fact  that 
the  parents  will  not  be  contacted,  without  the  applicant's  consent  if  the 
applicant  is  a  child,  requesting  Medi-Cal  for  minor  consent  services  in 
accordance  with  Section  50147.1. 

(4)  Exchange  of  income  and  eligibility  information  through  lEVS,  in- 
cluding the  fact  that  tax  information  will  be  obtained  and  that  lEVS  infor- 
mation will  be  used  to  verify  income  and  eligibility. 

(5)  Purposes,  provisions  and  availability  of  social  services,  the  Family 
Planning  Program,  Child  Health  Disability  Prevention  (CHDP)  Pro- 
gram, Special  Supplemental  Food  Program  for  Women,  Infants  and  Chil- 
dren (WIC)  and  other  public  or  private  resources. 

(A)  If  the  applicant  is  a  pregnant,  breastfeeding  or  postpartum  woman 
as  defined  in  Title  42,  United  States  Code,  Section  1786(b),  or  a  parent/ 
guardian  of  a  child  under  the  age  of  five,  the  applicant  shall  be  provided 
with  a  WIC  brochure  to  inform  them  of  the  availability  of  benefits  pro- 
vided under  WIC. 


Page  324 


Register  96,  No.  34;  8-23-96 


Title  22 


Health  Care  Services 


§  50157 


• 


• 


(B)  An  oral  explanation  of  the  Special  Supplemental  Food  Program  for 
WIC  benefits  shall  be  given  to  those  individuals  who  are  unable  to  read. 

(C)  Referrals  shall  be  made  to  the  WIC  program  for  all  such  individu- 
als as  specified  in  (A). 

(D)  The  representative  of  the  agency  conducting  the  interview  shall 
document  by  a  notation  on  the  Statement  of  Facts  that  the  requirements 
of  the  CHDP  program,  as  specified  in  subsections  (f)(5)  and  (k)  and  Sec- 
tion 501 84(b),  and  of  the  Special  Supplemental  Food  Program  for  Wom- 
en, Infants  and  Children  (WIC)  program  as  specified  in  (f)(5)  and  Section 
50184(c),  have  been  met. 

(6)  Possibility  of  being  included  in  a  quality  control  sample. 

(7)  Availability  of  Medi-Cal  prepaid  health  plans  and  PCCM  plans  in 
the  area. 

(8)  Right  to  request  a  fair  hearing. 

(9)  Responsibility  to  report  to  the  county  department  and  to  any  pro- 
vider of  health  care  services  any  existing  contractual  or  other  legal  en- 
titlement to  other  health  care  coverage;  and,  to  fully  utilize  other  health 
care  coverage  before  using  Medi-Cal  benefits.  The  information  to  be  re- 
ported shall  include  the  name  of  the  other  health  care  coverage,  policy 
and  group  numbers,  and  termination  date,  if  available.  Willful  failure  to 
comply  with  these  requirements  is  a  misdemeanor. 

(10)  Responsibility  to  report  to  the  county  department  the  availability 
of  any  option  to  obtain  other  health  care  coverage  through,  but  not  limited 
to,  the  beneficiary's  employer,  labor  union,  trust  fund,  spouse  or  parent 
and  to  provide  information  requested  by  the  Department  which  is  neces- 
sary to  determine  if  it  would  be  cost  effective  for  the  Department  to  pay 
the  premium  to  obtain  or  continue  other  health  care  coverage. 

(11)  Responsibility  to  apply  for,  and/or  retain  any  available  other 
health  care  coverage  when  there  is  no  premium  cost  to  the  beneficiary. 
Compliance  with  this  requirement  shall  be  a  condition  of  coverage  for 
Medi-Cal  covered  benefits  to  the  party  responsible  for  the  acquisition  or 
continuance  of  such  health  care  coverage,  and  shall  not  interfere  with 
Medi-Cal  benefits  provided  to  the  remaining  family  unit. 

(12)  Assignment  of  Rights  Requirements  as  follows: 

(A)  Assignment  to  the  state  by  an  applicant,  beneficiary,  caretaker  rel- 
ative, or  individual  applying  on  behalf  of  an  applicant,  of  all  rights  to 
medical  support  and  to  payments  for  medical  care  from  a  third  party  is 
a  condition  of  eligibility. 

(B)  Receipts  of  Medi-Cal  benefits  shall  constitute  an  assignment  by 
operation  of  law  except  as  provided  below.  This  means  that  receipt  of 
Medi-Cal  benefits  shall  constitute  automatic  assignment  of  these  rights 
that  the  individual  may  assign  on  his/her  behalf,  or  on  behalf  of  any  other 
family  member  for  whom  he/she  has  the  legal  authority  to  assign  such 
rights,  as  required  in  Section  50185. 

(C)  The  county  shall  advise  the  individual  that  he/she  has  the  right  to 
refuse  to  assign  these  rights  on  behalf  of  himself/herself  or  the  child  on 
whose  behalf  application  is  made. 

(D)  An  applicant,  beneficiary,  parent,  or  caretaker  relative  who  does 
not  wish  to  assign  his/her  rights  or  the  rights  of  a  person  for  whom  he/she 
can  legally  assign  rights  to  medical  support  and  payments  shall  be  given 
the  opportunity  to  withdraw  his/her  Medi-Cal  application,  as  specified 
in  Section  50155. 

(E)  Refusal  of  the  individual  to  assign  these  rights  shall  result  in  his/her 
denial  or  discontinuance  of  Medi-Cal  eligibility. 

(13)  Responsibility  of  the  applicant,  beneficiary,  parent,  caretaker  rel- 
ative, or  individual  applying  on  behalf  of  the  applicant,  to  cooperate  in: 

(A)  Identifying  and  locating  the  absent  parent. 

(B)  Estabhshing  paternity  for  a  child  bom  out  of  wedlock  for  whom 
Medi-Cal  is  requested. 

(C)  Obtaining  medical  support  and  payments. 

(D)  Identifying  and  providing  information  concerning  any  third  party 
who  is  or  may  be  liable  for  medical  care  and  services. 

Failure  of  the  applicant,  beneficiary,  parent,  caretaker  relative,  or  indi- 
vidual acting  on  behalf  of  an  applicant  to  comply  with  the  above  shall  re- 


sult in  denial  or  discontinuance  of  his/her  eligibility  unless  good  cause 
exists  for  not  cooperating,  as  specified  in  Section  50771.5.  If  the  appli- 
cant/beneficiary is  a  pregnant  woman,  cooperation  with  Sections  (A), 
(B),  and  (C)  above  is  waived  until  the  end  of  the  60-day  postpartum  peri- 
od. 

(14)  Applicant's  or  beneficiary's  responsibilities  as  specified  in  Sec- 
tions 50185  and  50187  which  include  but  are  not  limited  to: 

(A)  Responsibility  to  report  to  the  county  department  when  Medi-Cal 
may  be  billed  for  health  care  services  received  by  the  beneficiary  as  a  re- 
sult of  an  accident  or  injury  caused  by  some  other  person's  action  or  fail- 
ure to  act. 

(B)  Responsibility  to  report  any  changes  in  circumstances  which  may 
affect  eligibility  or  share  of  cost  within  10  calendar  days  following  the 
date  the  change  occurred. 

(C)  Responsibility  to  furnish  Social  Security  account  numbers  for  all 
persons  for  whom  Medi-Cal  is  requested. 

(D)  Responsibihty  to  apply  for  Medicare,  if  eligible,  and  furnish  the 
Health  Insurance  Claim  Number. 

(g)  During  the  interview,  the  representative  of  the  agency  conducting 
the  interview  shall  complete  and  explain  the  contents  of  the  following 
forms  if  the  forms  were  not  completed  during  screening: 

(1 )  Important  Information  for  Persons  Requesting  Medi-Cal  (MC  210 
Coversheet(9/91)) 

(2)  Statement  of  Facts  (Medi-Cal  (MC  210  (3/92)) 

(3)  Child  Support  Questionnaire  (CA  2.1  Q  Support  Questionnaire 
(3/93))  and  the  Child/Spousal  and  Medical  Support  Notice  and  Agree- 
ment (CA  2.1  Notice  of  Agreement  (12/89)); 

(4)  Child  Support  Enforcement  Program  Notice  (CS  1 96  (1 2/92));  and 
(h)  The  applicant  shall  sign  and  date  the  forms  referenced  in  subsec- 
tion (g). 

(i)  The  original  of  the  Important  Information  for  Persons  Requesting 
Medi-Cal  (MC  210  Coversheet  (9/91)),  and  a  copy  of  the  Child  Support 
Questionnaire  (CA  2.1  Q  Support  Questionnaire  (3/93)),  and  the  Child/ 
Spousal  and  Medical  Support  Notice  and  Agreement  (CA  2.1  Notice  of 
Agreement  (12/89))  shall  be  placed  in  the  case  file. 

(j)  A  copy  of  each  relevant  form  referenced  in  i  shall  be  given  to  the 
persons  being  interviewed  and  the  originals  of  the  Child  Support  Ques- 
tionnaire (CA  2.1  Q  (3/93))  and  the  Child/Spousal  and  Medical  Support 
Notice  and  Agreement  (CA  2.1  Notice  of  Agreement  (12/89))  shall  be 
forwarded,  within  two  working  days,  to  the  district  attorney. 

(k)  An  informational  pamphlet  on  the  CHDP  program  shall  be  given 
to  the  applicant,  if  there  are  persons  under  21  years  of  age  in  the  family, 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  11004,  14000,  14001,  14005,  14005.4,  14008.6, 
14010,  14011,  14012,  14023,  14088.3,  14100.2  and  14124.91,  Welfare  and  Insti- 
tutions Code;  and  Section  1902(a),  Social  Security  Act,  Title  42,  United  States 
Code,  Section  1786(b);  Title  42,  United  States  Code,  Sections 
1396a(a)(ll),(51),(52)  and  (53);  Title  42,  Code  of  Federal  Regulations,  Section 
431.635;  42  CFR,  Subpart  M,  431 .635;  and  42  C.F.R.  Sections  433. 135, 433.136, 
433.137,  433.138,  433.145,  433.146,  433.147,  433.148  and  435.604. 

History 

1.  Amendment  of  subsection  (c)  filed  12-15-77;  effective  thirtieth  day  thereafter 
(Register77,  No.  51). 

2.  Amendment  filed  9-1-78;  effective  thirtieth  day  thereafter  (Register  78,  No. 
35). 

3.  Amendment  of  subsection  (d)(3)  filed  8-8-80;  effective  thirtieth  day  thereafter 
(Register  80,  No.  32). 

4.  Amendment  filed  1-8-81 ;  effective  thirtieth  day  thereafter  (Register  8 1 ,  No.  2). 

5.  Editorial  correction  filed  7-7-83  (Register  83,  No.  29). 

6.  Amendment  of  subsection  (f)  filed  7-16-87;  operative  7-16-87  pursuant  to 
Government  Code  section  11346.2(d)  (Register  87,  No.  30). 

7.  Amendment  of  subsection  (f)  filed  6-28-89;  operative  7-28-89  (Register  89, 
No.  26). 

8.  Amendment  of  subsection  (f)(7)  filed  3-9-90  as  an  emergency;  operative 
3-9-90  (Register  90,  No.  12).  A  Certificate  of  Compliance  must  be  transmitted 
to  OAL  within  120  days  or  emergency  language  will  be  repealed  on  7-9-90. 

9.  Amendment  refiled  7-9-90  as  an  emergency;  operative  7-9-90  (Register  90, 
No.  35).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  by  operation  of  law  on  11-6-90. 


Page  325 


Register  96,  No.  34;  8-23-96 


§  50159 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


10.  Request  to  readopt  amendment  on  an  emergency  basis  pursuant  to  Govern- 
ment Code  section  1 1346.1  granted  and  filed  11 -6-90  as  an  emergency;  opera- 
live  1 1-6-90  (Register  91,  No.  6).  A  Certificate  of  Compliance  must  be  trans- 
mitted to  OAL  by  3-6-91  or  emergency  language  will  be  repealed  by  operation 
of  law  on  the  following  day. 

1 1 .  Certificate  of  Compliance  as  to  1 1  -6-90  order  transmitted  to  OAL  2-22-91 ; 
disapproved  by  OAL  on  3-25-91  (Register  9L  No.  18). 

12.  Amendment  of  subsection  (f)  filed  3-25-91  as  an  emergency;  operative 
3-25-91  (Register91,No.  18).  A  Certificate  ofCompliance  must  be  transmitted 
to  OAL  by  7-23-91  or  emergency  language  will  be  repealed  by  operation  of  law 
on  the  following  day. 

13.  Certificate  ofCompliance  as  to  3-25-91  order  transmitted  to  OAL  7-19-91 
and  filed  8-19-91  (Register  92,  No.  1). 

14.  Amendment  of  section  and  Note  filed  4-16-93  as  an  emergency;  operative 
4-16-93  (Register  93,  No.  16).  A  Certificate  ofCompliance  must  be  transmitted 
to  OAL  8-16-93  or  emergency  language  will  be  repealed  by  operation  of  law 
on  the  following  day. 

15.  Certificate  ofCompliance  as  to  4-1 6-93  order  includins  amendment  of  Note 
transmitted  to  OAL  8-13-93  and  filed  9-23-93  (Register  93,  No.  39). 

16.  Amendment  of  subsection  (f)(5),  new  subsections  (f)(5)(A)-(D).  repealer  of 
subsection  (/)  and  amendment  of  Note  filed  8-22-96;  operative  9-21-96  (Reg- 
ister 96,  No.  34). 

§  501 59.    Statement  of  Facts. 

(a)  Following  completion  of  the  application  form,  a  Statement  of  Facts 
shall  be  completed,  signed  and  filed  with  the  county  department. 

(b)  The  Statement  of  Facts  shall  be  used  by  the  county  department  in 
the  determination  of  the  applicant's: 

(1)  Eligibility. 

(2)  Share  of  cost. 

(3)  Other  health  care  coverage. 

§  501 61 .    Statement  of  Facts  Form. 

(a)  A  Statement  of  Facts  is  not  required  in  determining  Medi-Cal 
eligibility  for  a  child  receiving  aid  under  the  Aid  for  Adoption  of  Chil- 
dren program. 

(b)  A  public  agency,  applying  on  behalf  of  a  child  who  may  be  ehgible 
as  an  MI  child  who  is  not  living  with  a  parent  or  relative  and  for  whom 
a  public  agency  is  assuming  financial  responsibility  in  whole  or  in  part, 
shall  complete  the  Application  and  Statement  of  Facts  for  Child  in  Foster 
Care  Supported  by  Public  Funds,  MC  250. 

(c)  An  applicant  applying  for  Medi-Cal  under  any  other  program  shall 
complete  the  Statement  of  Facts,  form  MC  210. 

(d)  A  person  applying  for  Medi-Cal  and  requesting  retroactive  cover- 
age shall  complete  the  appropriate  Statement  of  Facts  for  the  current 
month  and  the  Supplement  to  Statement  of  Facts  for  Retroactive  Covera- 
ge/Restoration, MC  213,  for  the  retroactive  months.  If  only  retroactive 
coverage  is  requested,  a  Statement  of  Facts,  MC  210,  shall  be  completed 
for  one  retroactive  month  for  which  Medi-Cal  is  requested  and  the  MC 
213  shall  be  completed  for  each  additional  retroactive  month. 

(e)  An  applicant  or  beneficiary  who  has  a  form  CA  2  which  has  been 
completed  within  the  last  1 2  months  and  which  is  on  file  with  the  county 
department  need  not  complete  the  MC  210,  unless  the  county  department 
determines  that  the  applicant's  or  beneficiary's  circumstances  have 
changed  to  such  a  degree  as  to  require  a  new  Statement  of  Facts. 

(0  Any  person  requesting  a  restoration  of  Medi-Cal-only  eligibility 
shall  complete  the  Supplement  to  Statement  of  Facts  for  Retroactive 
Coverage/Restoration,  form  MC  213,  unless  the  county  department  de- 
termines that  the  applicant's  circumstances  have  changed  to  such  a  de- 
gree as  to  require  a  new  MC  210,  or  unless  a  new  MC  210  is  required  as 
part  of  redetermination  of  eligibility  under  Section  50189. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14005.4,  Welfare  and  Institutions  Code. 

History 

1.  Amendment  of  subsection  (c)  filed  12-15-77;  effective  thirtieth  day  thereafter 
(Register  77,  No.  51). 

2.  Amendment  filed  8-7-78;  effective  thirtieth  day  thereafter  (Register  78,  No. 
32). 

3.  Amendment  of  subsection  (b)  filed  8-8-80;  effective  thirtieth  day  thereafter 
(Register  80,  No.  32). 


§  50163.    Persons  Who  May  Complete  and  Sign  the 
Statement  of  Facts. 

(a)  The  apphcant  or  spouse  of  the  applicant  shall  complete  and  sign  the 
Statement  of  Facts,  unless: 

(1 )  The  applicant  is  a  child.  Generally,  the  person  or  agency  having  le- 
gal responsibility  for  the  child  shall  complete  and  sign  the  Statement  of 
Facts.  The  child  shall  complete  and  sign  the  Statement  of  Facts  if  the 
child  is  competent  and  either  of  the  following  applies: 

(A)  The  child  is  not  Hving  with  the  child's  parents  or  caretaker  rela- 
tives and  the  county  has  determined  that  no  person  or  agency  accepts  le- 
gal responsibiUty  for  the  child. 

(B)  The  child  is  applying  on  his  or  her  own  behalf  in  accordance  with 
Section  50147.1  (a). 

(2)  The  apphcant  has  a  conservator,  guardian  or  executor.  In  this  case, 
the  conservator,  guardian  or  executor  shall  complete  and  sign  the  State- 
ment of  Facts. 

(3)  The  applicant  is  incompetent,  in  a  comatose  condition  or  suffering 
from  amnesia,  and  there  is  no  spouse,  conservator,  guardian  or  executor. 
In  this  case: 

(A)  The  county  department  shall  evaluate  the  applicant's  circum- 
stances and  determine  whether  or  not  there  is  a  need  for  protective  ser- 
vices. 

(B)  The  Statement  of  Facts  may  be  completed  and  signed  on  the  appli- 
cant'sbehalfby  a  relative,  a  person  who  has  knowledge  of  the  applicant's 
circumstances,  or  a  representative  of  a  public  agency  or  the  county  de- 
partment. 

(C)  The  person  completing  the  Statement  of  Facts  on  behalf  of  the 
applicant  shall  provide  all  available  information  required  on  the  State- 
ment of  Facts  regarding  the  applicant's  circumstances. 

(D)  If  a  county  department  representative  completes  and  signs  the 
Statement  of  Facts,  another  representative  of  that  county  department 
shall: 

1.  Confirm,  by  personal  contact,  the  applicant' s  inability  to  act  on  his 
own  behalf. 

2.  Countersign  and  approve  any  recommendations  for  eligibility. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  11054,  14000,  14001,  14005.1,  14005.4,  14005.7, 
14008,  14008.5,  14010,  14011,  14017,  14018  and  14051.5,  Welfare  and  Institu- 
tions Code;  Sections  25.6,  34.5,  34.7,  34.9  and  34.10,  Civil  Code. 

History 

1.  Amendment  of  subsection  (a)(1)  filed  10-31-78  as  an  emergency;  designated 
effective  1 1-1-78  (Register  78,  No.  44). 

2.  Certificate  ofCompliance  filed  2-6-79  (Register  79,  No.  6). 

3.  Amendment  filed  5-30-79  as  an  emergency;  designated  effective  6-1-79  (Reg- 
ister 79,  No.  22). 

4.  Certificate  ofCompliance  filed  9-19-79  (Register  79,  No.  38). 

5.  Amendment  of  subsection  (a)(1)(A)  filed  2-1 1-82;  effective  thirtieth  day  there- 
after (Register  82,  No.  7). 

6.  Editorial  correction  of  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  501 65.     Filing  the  Statement  of  Facts. 

(a)  At  the  time  the  Statement  of  Facts  is  given  or  mailed  to  an  applicant, 
the  county  department  shall: 

( 1 )  Set  a  reasonable  deadline  for  returning  the  Statement  of  Facts  to  the 
county  department. 

(2)  Inform  the  applicant  of  the  deadline. 

(b)  If  the  Statement  of  Facts  is  not  returned  personally  or  by  mail  by 
the  deadline  specified  in  (a),  the  county  department  shall: 

(1)  Attempt  to  contact  the  applicant  or  beneficiary  to  determine  the 
reason  for  the  delay. 

(2)  Extend  the  deadline  for  returning  the  Statement  of  Facts  if  a  valid 
reason  for  the  delay,  such  as  incapacity,  is  found. 

(3)  Deny  the  application  or  discontinue  eligibility  if  a  valid  reason  for 
the  delay  cannot  be  established. 

(c)  A  copy  of  the  completed  Statement  of  Facts  shall  be  provided  to 
the  individual  who  signed  it,  at  the  request  of  that  individual. 


Page  326 


Register  96,  No.  34;  8-23-96 


• 


Title  22  Health  Care  Services  §  50166 

NOTE:  Authority  cited:  Sections  10725  and  141 24.5,  Welfare  and  Institutions  completing    the    Statement    of   Facts    in    accordance    with    Section 

Code. Reference: Sections  10001, 10060, 1 1004, 1 1050, 11054, 14001, 14011  and  50163(a)(3)  shall: 

14012.  Welfare  and  Institutions  Code.  '    /ind    r  j-i-       .  u^      u    ■  -i  ui    •   r         .•  j- 

History  (l)Periorm  a  dihgent  search  to  obtam  available  information  regarding 

1.  Amendment  of  subsection  (a)  filed  12-15-77;  effective  thirtieth  day  thereafter  ^he  applicant's  circumstances  applicable  to  Medi-Cal  eligibility  deter- 
(Register  77,  No.  51).  mination. 

2.  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29).  (2)  Complete  the  Statement  of  Facts  based  upon  the  findings  of  the  dil- 

§  50166.    Obtaining  Information  for  the  Completion  of  the  igent  search. 
Statement  of  Facts. 

(a)  The  county  department  or  the  representative  of  a  public  agency 


[The  next  page  is  327.] 


Page  326.1  Register  96,  No.  34;  8-23-96 


Title  22 


Health  Care  Services 


§  50167 


(3)  Establish  disability  in  accordance  with  Section  50167(a)(1). 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institution.s 
Code.  Reference:  Sections  1 1054, 14000,  14001 ,  and  1401 1,  Welfare  and  Institu- 
tions Code. 

History 

1 .  New  section  filed  5-30-79  as  an  emergency;  designated  effective  6-1-79  (Reg- 
ister 79,  No.  22). 

2.  Certificate  of  Compliance  filed  9-19-79  (Register  79,  No.  38). 


§  501 67.     Verification — Prior  to  Approval. 

(a)  With  regard  to  information  on  the  Statement  of  Facts,  the  county 
department  shall  obtain  verification  of  the  following  items  in  the  manner 
specified  below,  prior  to  approval  of  eligibility: 

(1)  Blindness,  as  determined  in  accordance  with  Section  50219,  and 
federal  disability,  as  determined  in  accordance  with  Section  50223  (a)(1) 
or  (b),  shall  be  verified  by  any  of  the  following  methods: 

(A)  By  determining  that  the  person  was  eligible  as  an  MN  person  on 
the  basis  of  blindness  or  disability  in  December  1973,  and  that  there  has 
been  continuing  eligibility  since  that  time. 

(B)  By  obtaining  verification  that  a  prior  determination  of  blindness 
or  disability  is  still  valid.  Verification  shall  be  documented  by  viewing 
any  of  the  following  or  si  milar  items  and  noting  in  the  case  record  the  date 
of  the  award  letter  or  notification  and  the  disability  onset  and  reexamina- 
tion dates: 

1.  A  Social  Security  Administration  Title  II  award  letter  indicating  re- 
ceipt of  disability  benefits  provided  the  reexamination  date  has  not 
passed  or  a  reexamination  date  is  not  indicated  and  the  applicant  is  still 
receiving  those  benefits. 

2.  A  Social  Security  Administration  notification  that  Title  II  disability 
benefits  have  been  increased  or  decreased  provided  the  applicant  is  still 
receiving  those  benefits. 

3.  A  Railroad  Retirement  Board  notification  of  a  total  and  permanent 
disability  award  provided  the  applicant  is  still  receiving  those  benefits. 

4.  A  signed  statement  from  the  Social  Security  Administration  that 
states  that  the  person  is  eligible  for  Title  II  benefits  on  the  basis  of  a  dis- 
ability. 

5.  Documentation  of  a  prior  determination  of  disability  under  the  MN 
program,  if  the  determination  was  performed  within  the  last  12  months 
unless: 

a.  The  reexamination  date  has  passed. 

b.  The  applicant  indicates  his/her  physical  or  mental  condition  has  im- 
proved. 

6.  Data  on  the  SDX  or  a  signed  statement  from  the  Social  Security  Ad- 
ministration indicating  that  a  person  was  discontinued  from  SSI/SSP  for 
reasons  other  than  cessation  of  disability  provided  the  procedures  speci- 
fied in  (D)  are  followed  within  twelve  months  of  the  SSI/SSP  discontinu- 
ance date. 

(C)  By  obtaining  a  letter  from  a  physician  verifying  any  of  the  physical 
or  mental  impairments  meeting  the  federal  definition  of  presumptive  dis- 
ability or  blindness  contained  in  Title  20,  Code  of  Federal  Regulations, 
Section  416.934,  provided  the  procedures  specified  in  (D)  are  followed 
after  eligibility  is  determined. 

(D)  By  following  procedures  established  by  the  California  Depart- 
ment of  Social  Services,  Disability  Evaluation  Division.  All  necessary 
information  shall  be  submitted  to  that  division  not  later  than  10  days  after 
the  receipt  of  the  Statement  of  Facts  by  the  county,  except  in  the  event 
of  a  delay  due  to  circumstances  beyond  the  control  of  the  county. 

(2)  Incapacity,  as  defined  in  Section  5021 1 ,  shall  be  verified  by  view- 
ing one  of  the  following: 

(A)  A  current  Medical  Report  form  or  written  statement  signed  by  a 
physician,  licensed  or  certified  psychologist  or  authorized  member  of 
their  staff  which  documents  that  incapacity  exists  and  gives  the  expected 
duration  of  the  condition. 

(B)  A  current  Certificate  of  Disability  form. 

(C)  Documentation  of  current  receipt  of  Title  II  or  Railroad  Retire- 
ment disability  benefits. 


(D)  Documentation  of  current  receipt  of  SSI/SSP  benefits  based  on 
disability  or  blindness. 

(E)  Documentation  of  current  receipt  of  State  Disability  Insurance 
(SDI)  or  Worker's  Compensation. 

(F)  If  a  current  Medical  Report  form  or  a  written  statement  cannot  be 
obtained  without  delay,  and  no  other  verification  of  incapacity  exists,  a 
verbal  statement  from  one  of  the  persons  specified  in  (A)  shall  be  ac- 
cepted as  verification  for  up  to  60  days  pending  receipt  of  written  verifi- 
cation. 

(3)  Alien  status  shall  be  verified  in  accordance  with  the  alienage  verifi- 
cation and  documentation  procedures  described  in  Article  7. 

(4)  The  fact  that  the  parents  and  a  public  or  private  agency  will  not  ac- 
cept legal  responsibility  for  a  child  shall  be  verified  by  documented  ver- 
bal or  written  communication  with  the  parents  and  agencies,  if  the  child 
is  applying  alone  on  the  basis  that  neither  the  parents  nor  an  agency  will 
accept  legal  responsibility. 

(5)  SGA  disability,  as  determined  in  accordance  with  Section  50223 
(a)  (2),  shall  be  verified  by  following  procedures  established  by  the  De- 
partment of  Social  Services,  Disability  Evaluation  Division.  All  neces- 
sary information  shall  be  submitted  to  the  Department  of  Social  Services 
by  the  county  not  later  than  10  days  after  the  receipt  of  the  Statement  of 
Facts  by  the  county,  except  in  the  event  of  a  delay  due  to  circumstances 
beyond  the  control  of  the  county. 

(6)  Identity  of  all  persons  other  than  those  listed  in  (D).  Identity  shall 
be  verified  by  viewing  one  of  the  following: 

(A)  California  driver's  license. 

(B)  Identification  card  issued  by  the  Department  of  Motor  Vehicles. 

(C)  Any  other  document  which  appears  to  be  valid  and  establishes 
identity. 

(D)  Persons  who  are: 

1.  In  an  institution  and  contact  is  made  with  the  facility  to  verify  pres- 
ence in  the  institution. 

2.  Receiving  Medi-Cal  through  the  Aid  for  Adoption  of  Children  pro- 
gram. 

3.  Children  in  a  family,  if  identity  of  one  parent  has  been  verified 

4.  Children  requesting  Medi-Cal  for  minor  consent  services  in  accor- 
dance with  Section  50147.1. 

5.  MI  children  who  are  not  living  with  a  parent  or  relative  and  for 
whom  a  public  agency  is  assuming  financial  responsibility  in  whole  or 
in  part. 

6.  Not  acting  on  their  own  behalf  and  a  government  representative, 
such  as  a  public  guardian,  is  acting  for  them. 

7.  The  spouse  of  a  person  whose  identity  has  been  verified. 

(7)  The  following  income  and  resources: 

(A)  Unearned  income,  which  shall  be  verified  by  viewing  any  of  the 
following: 

1.  Data  from  the  lEVS  which  confirms  information  on  the  Statement 
of  Facts. 

2.  Checks  or  copies  of  checks.  County  departments  shall  not  require 
copies  of  checks  issued  by  the  United  States  Government. 

3.  Award  letters. 

4.  Signed  statements  from  persons  or  organizations  providing  the  in- 
come. 

5.  Check  stubs. 

6.  Statements  from  checking,  savings  or  trust  fund  accounts  which  in- 
dicate that  the  income  is  directly  deposited  for  the  applicant  or  beneficia- 
ry by  the  persons  or  organizations  providing  the  income. 

7.  The  statement  of  the  person  completing  the  Statement  of  Facts,  for 
income  received  from  the  United  States  Government.  This  statement 
shall  constitute  verification  pending  receipt  by  the  county  department  of 
verification  from  appropriate  government  agency,  when  the  verification 
in  1  through  6  cannot  be  provided. 

(B)  Income  in  kind,  which  shall  be  verified  by  a  written  statement  from 
the  provider  of  the  items  of  need.  Verification  shall  be  limited  to  those 
items  which  the  appHcant  is  claiming  have  a  lower  value  than  the  values 
estabhshed  in  accordance  with  Section  5051 1  (b). 


Page  327 


Register  96,  No.  47;  11-22-96 


§  50167 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


(C)  Earned  income,  which  shall  be  verified  by  viewing  paycheck 
stubs.  If  paycheck  stubs  are  not  available,  a  signed  statement  from  the 
employer  verifying  the  amount  and  frequency  of  the  payments  shall  be 
obtained.  If  an  individual  is  self-employed,  records  kept  by  such  individ- 
ual for  tax  purposes  shall  be  viewed. 

1.  Therapeutic  Wages  as  defined  in  Section  50095.5  shall  be  verified 
by  obtaining  all  of  the  following: 

a.  A  statement  from  the  individual's  physician  which  provides  that  he/ 
she  has  no  financial  interest  in  the  LTC  facility  in  which  the  individual 
resides  and  that  the  work  has  been  prescribed  as  therapy  for  the  individu- 
al. 

b.  A  statement  from  the  facility  in  which  the  individual  resides  verify- 
ing the  individual's  employment  by  that  facility  and  that  such  employ- 
ment does  not  displace  any  existing  employees. 

c.  A  statement(s)  from  the  facility(ies)  verifying  that  the  individual  has 
been  an  LTC  resident  for  a  continuous  period  commencing  at  least  five 
years  prior  to  September,  1984. 

d.  The  provisions  of  this  regulation  also  apply  to  eligibility  determina- 
tion or  redeterminations  made  retroactively  to  October  1,  1984. 

(D)  Fluctuating  income,  which  shall  be  verified  by  viewing  check 
stubs  or  a  copy  of  the  checks  that  show  the  amount  of  income.  If  these 
are  not  available  a  signed  statement  from  the  person  or  organization  mak- 
ing the  payments  verifying  the  amount  and  frequency  of  the  payments 
shall  be  obtained. 

(E)  Child  care  costs,  which  shall  be  verified  by  viewing  receipts  and/or 
canceled  checks. 

(F)  Cost  of  care  for  an  incapacitated  person  wliile  someone  else  is 
employed,  which  shall  be  verified  by  viewing  receipts  and/or  canceled 
checks. 

(G)  Deductible  expenses  for  maintenance  or  improvement  of  income- 
producing  property,  as  defined  in  Section  50508,  which  shall  be  verified 
by  viewing  actual  receipts  for  such  services  or  a  signed  statement  from 
the  person  providing  the  service  or  goods  verifying  the  nature  and  cost 
of  the  service  or  goods. 

(H)  The  market  value  of  real  property,  other  than  the  principal  resi- 
dence, which  shall  be  verified  by  viewing  any  of  the  following: 

1.  A  current  incorporated  tax  statement  from  the  county  Tax  Asses- 
sor's Office. 

2.  Records  maintained  by  the  County  Tax  Assessor. 

3.  A  written  statement  from  a  qualified  real  estate  appraiser  which 
gives  the  appraisal  value  of  the  property,  when  the  applicant  chooses  to 
meet  the  conditions  of  Section  50412(a)(3). 

(I)  Checking  or  savings  account  balances,  which  shall  be  verified  by 
viewing  either  of  the  following: 

1.  A  current  account  statement  from  the  institutions  holding  the  funds. 

2.  Signed  correspondence  from  the  institution  holding  the  funds. 

(J)  The  value  of  stocks,  bonds  and  mutual  funds,  which  shall  be  veri- 
fied by  both: 

1.  Viewing  the  certificate  or  a  signed  statement  from  the  issuing  insti- 
tution stating  a  description  of  the  investment,  including  the  number  of 
shares  owned. 

2.  Taking  one  of  the  following  actions: 

a.  Telephone  contact  with  a  recognized  stock  exchange  broker  to  es- 
tablish at  the  current  selling  price  of  the  property. 

b.  Establishment  of  the  current  selling  price  of  the  property  through 
listings  in  a  current  newspaper. 

(K)  U.S.  Savings  Bonds  values,  which  shall  be  verified  by  viewing  the 
bond  and  by  contacting  any  bank  or  institution  where  such  bonds  may  be 
liquidated. 

(L)  The  value  of  deeds  of  trusts,  mortgages  and  other  promissory 
notes,  which  shall  be  verified  by  both: 

1 .  Viewing  documents  which  state  a  description  of  the  item. 

2.  Taking  one  of  the  following  actions: 

a.  Viewing  documents  from  the  lender  which  establish  the  principal 
amount  remaining  on  the  note. 


b.  Viewing  an  appraisal  obtained  from  a  party  qualified  to  appraise 
mortgages  and  notes  as  described  in  Section  50441  (c)(2). 

c.  Making  a  telephone  contact  with  a  recognized  broker  who  buys, 
sells  or  appraises  such  items. 

(M)  The  value  of  nonexempt  motor  vehicles,  boats,  campers  or  trail- 
ers, which  shall  be  verified  by  viewing  the  appropriate  document  as  fol- 
lows: 

1.  Vehicle  registration. 

2.  Appraisal  statements  when  obtained  pursuant  to  Sections  50461  and 
50463. 

(N)  The  cash  surrender  value  of  nonexempt  life  insurance  policies, 
which  shall  be  verified  by  viewing  either  of  the  following: 

1.  The  value  tables  included  in  the  policy. 

2.  Signed  correspondence  from  the  carrier  indicating  the  current  value. 
(O)  The  value  of  nonexempt  jewelry,  which  shall  be  verified  by  re- 
viewing the  appraisal  statements. 

(P)  The  value  of  burial  trusts  or  prepaid  burial  contracts,  which  shall 
be  verified  by  viewing  the  actual  trust  or  contract  or  by  viewing  signed 
correspondence  from  the  trustor  or  contractor  which  details  its  value. 

(Q)  The  value  of  nonexempt  property  held  in  trust,  which  shall  be  veri- 
fied by  viewing  either  of  the  following: 

1.  A  document  indicating  the  trust's  current  value,  executed  by  the 
trustor  or  executor. 

2.  An  appraisal  of  the  property  obtained  by  the  applicant  from  an  agent 
qualified  to  appraise  such  property. 

(R)  Encumbrances  of  record  on  any  item  of  property  subject  to  verifi- 
cation, which  shall  be  verified  by  either  of  the  following: 

1 .  A  payment  book  issued  by  the  insfitution  or  person  holding  the  en- 
cumbrance which  indicates  the  current  amount  of  the  encumbrance. 

2.  Written  correspondence  stating  the  amount  of  the  encumbrance  ob- 
tained by  the  applicant  from  the  institution  or  person  holding  the  encum- 
brance. 

(S)  The  value  of  oil  leases  or  mineral  rights  which  shall  be  verified  by 
one  of  the  following: 

1 .  Written  or  telephone  contact  with  a  member  of  a  recognized  profes- 
sional appraisal  society  which  establishes  the  current  market  value  of  the 
lease  or  right. 

2.  Viewing  records  maintained  by  the  county  tax  assessor  where  the 
lease  or  right  is  located. 

3.  Written  or  telephone  contact  with  the  company/organization  devel- 
oping the  natural  resource  which  establishes  the  current  market  value. 

(T)  Health  care  benefits  available  through  employment,  retirement  or 
military  service  which  shall  be  verified  by  viewing  those  insurance  poli- 
cies which  specifically  name  the  applicant,  health  benefit  identificafion 
cards,  or  letters  from  health  care  benefit  providers.  Health  care  benefits 
available  through  work  related  injuries  or  settlements  from  prior  injuries 
shall  be  verified  by  viewing  letters  from  the  Workmen's  Compensation 
Board,  employers,  or  insurance  companies. 

(U)  Application  for  uncondidonally  available  income  as  determined 
in  accordance  with  Section  50186,  which  shall  be  verified  by  viewing: 

1.  A  Veterans  Benefit  Referral  form,  referral  for  veterans  benefits. 

2.  Application  printouts  for  disability  insurance  benefits. 

3.  Application  printouts  for  unemployment  insurance  benefits. 

4.  Application  receipts  for  OASDI  benefits. 

5.  Application  receipts  for  any  other  uncondifionally  available  income 
source. 

(V)  Employee  retirement  contributions  and  other  employee  benefit 
contributions  which  shall  be  verified  by  viewing  a  statement  from  the 
employer. 

(8)  Except  for  women  applying  for  minor  consent  services  under  Sec- 
tion 50147. 1 ,  a  woman  whose  eligibility  or  share  of  cost  is  based  on  preg- 
nancy shall  provide  a  letter  of  verification  from  either  a  physician  or  a 
person  certified  as  a  nurse  pracfitioner,  midwife  or  physician's  assistant. 

(9)  Property  as  defined  in  SecUon  50425  (a)(7)  is  listed  for  sale  with 
a  licensed  real  estate  broker  at  its  fair  market  value  and  a  bona  fide  at- 


Page  328 


Register  96,  No.  47;  11-22-96 


Title  22 


Health  Care  Services 


§  50168 


tempt  is  being  made  to  sell  such  property.  This  shall  be  verified  by  view- 
ing a  listing  contract  and  appraisal  from  a  qualified  real  estate  appraiser. 
(10)  California  residency  shall  be  verified  in  accordance  with  Sections 
50320.1  and  50320.2. 

(b)  The  provisions  of  this  section  apply  to  all  items  listed  in  (a)  at: 

(1)  Initial  application  and  reapplication. 

(2)  The  time  a  change  is  reported  or  at  redetermination  for  items  not 
previously  verified. 

(3)  Redetermination  for  items  which  the  county  determines  could  have 
appreciated  in  value  since  the  last  verification. 

(c)  The  applicant  or  the  county  shall  make  a  diligent  search  to  obtain 
documentation  necessary  to  verify  items  (a)(7)(A)  through  (a)(7)(V)  and 
(a)(9)  above.  Such  a  search  shall  include  at  a  minimum,  one  contact  with 
the  appropriate  person/organization  from  which  this  documentation 
could  be  obtained.  When  the  county  determines  that  such  documentation 
cannot  be  obtained  either  by  the  applicant  or  by  county  within  the 
promptness  requirements  listed  in  Section  50177.  the  county  shall: 

(1)  List  and  retain  in  the  case  record  all  actions  taken  to  obtain  docu- 
mentation required  for  verification. 

(2)  Obtain  from  the  applicant,  and  retain  in  the  case  record,  an  affidavit 
dated  and  signed  by  the  applicant  under  penalty  of  perjury  which  lists  a 
description  and  value  of  any  item  for  which  documentation  for  verifica- 
tion purposes  was  determined  not  available. 

(3)  Obtain  a  signed  and  dated  affidavit  from  the  applicant  under  penal- 
ty of  perjury  which  hsts  the  amounts  of  any  earned  or  unearned  income 
received  and  retain  this  document  in  the  case  record. 

NOTE:  Authoritv  cited:  Sections  10725. 10740, 14006.1  and  14124.5,  Welfare  and 
Institutions  Code.  Reference:  Sections  12305.5,  14001,  14005.1,  14005.3, 
14005.4,  14005.7,  14005.13,  14006,  14007.5,  14008,  14010,  14011,  14017, 
14018,  14051.5,  14148  and  14148.5,  Welfare  and  Institutions  Code;  Sections 
25.6.  34.5,  34.7,  34.9  and  34.10,  Civil  Code;  Section  66  of  Chapter  722,  Statutes 
of  1992;  Title  20,  Code  of  Federal  Regulations,  Section  416.934;  and  42  Code  of 
Federal  Regulations,  435.948. 

History 

1.  Amendment  of  subsection  (a)(8)  filed  6-27-89  as  an  emergency;  operative 
6-27-89  (Register  89,  No.  26).  A  Certificate  of  Compliance  must  be  transmitted 
to  OAL  within  120  days  or  emergency  language  will  be  repeated  on  10-25-89. 
For  prior  history,  see  Register  87,  No.  30. 

2.  Certificate  of  Compliance  transmitted  to  OAL  10-25-89  and  filed  11-22-89 
(Register  89,  No.  48). 

3.  Amendment  of  subsection  (a)(1)  filed  4-17-89;  operative  5-17-89  (Register 
89,  No.  48). 

4.  New  subsection  (a)(10)  and  amendment  of  Note  filed  5-1 7-93  as  an  emergen- 
cy with  Secretary  of  State  by  the  Department  of  Health  Services;  operative 
5-1 7-93.  Submitted  to  OAL  for  printing  only  pursuant  to  1992  Senate  Bill  485 
(Register93,  No.  21). 

5.  Amendment  of  subsections  (a)(  1  )(B)  1  .-2.,  (a)(  1  )(B)4.-5.  and  (a)(  1  )(C),  repeal- 
er of  subsections  (a)(1)(C)  1.-13.,  amendment  of  subsections  (a)(1)(D)  and 
(a)(2),  and  amendment  of  Note  filed  1 1-20-96;  operative  12-20-96  (Register 
96,  No.  47). 


§  501 67.2.    Verification  of  Income — lEVS  Requirements. 

(a)  In  administering  the  Medi-Cal  program,  the  county  department 
shall  adhere  to  the  requirements  in  Division  20.006,  Manual  of  Policy 
and  Procedures,  Department  of  Social  Services,  governing: 

(1)  Submission  of  information  to  lEVS  on  applicants,  beneficiaries 
and  any  other  family  member  whose  income  and  resources  are  consid- 
ered in  establishing  eligibility  and  share  of  cost,  for  persons  in  long-term 
care  status  except  as  provided  in  (c). 

(2)  Use  of  matched  lEVS  information  received  from  the  Departments 
of  Health  Services  and  Social  Services. 

(3)  Time  requirements  for  completing  case  action  based  on  lEVS  in- 
formation. 

(4)  Maintenance  of  records. 

(5)  Submission  of  reports. 

(b)  The  county  department  shall  review  and  compare  the  lEVS  infor- 
mation against  information  contained  in  the  case  file  and  shall  verify  that 
lEVS  information  pertains  to  the  applicant,  beneficiary  or  other  family 
member  and  is  applicable  to  case  circumstances  in  accordance  with  pro- 


cedures established  by  the  Department  prior  to  taking  case  action  based 
upon  lEVS  information  alone. 

(c)  The  county  departtnent  shall  submit  information  on  persons  in 
Long-Term  Care  status  only  at  application  and  at  the  annual  redetermi- 
nation. 

(d)  In  addition  to  the  requirements  of  (a)  the  county  department  shall 
submit  to  the  Department  for  submittal  to  the  State  Wage  Information 
Collection  Agency,  the  name  and  Social  Security  Number  of  the  absent 
parent  of  any  child  in  the  MFBU  to  the  extent  such  information  is  avail- 
able in  order  to  identify  employers  of  the  absent  parent  and  any  third 
party  liability. 

NOTE:  Authority  cited:  Sections  10725.  10740  and  14124.5.  Welfare  and  Institu- 
tions Code.  Reference:  42  Code  of  Federal  Regulations  433.138(c)  and  (d),  and 
435.940-435.965. 

History 
1.  New  section  filed  7-16-87;  operative  7-16-87  pursuant  to  Government  Code 
Section  11346.2(d)  (Register  87,  No.  30). 

§  50167.5.     Verification  of  Unearned  Income  Information 
from  Internal  Revenue  Service  (IRS)  or 
Franchise  Tax  Board  (FIB)— lEVS 
Requirements. 

(a)  The  county  departtnent  shall  not  deny  or  terminate  benefits  to  an 
applicant  or  beneficiary  or  increase  the  share  of  cost  based  on  unearned 
income  information  from  IRS  or  FTB  until  it  has: 

(1)  Verified  the  amount  of  the  income  and  the  value  of  the  property  in- 
volved. 

(2)  Established  whether  the  income  or  property  was  available  to  the  in- 
dividual. 

(3)  Determined  the  period  or  periods  when  the  individual  actually  had 
the  income  or  property. 

(b)  The  county  department  shall  verify  the  IRS  or  FTB  information  by 
either: 

(1)  Contacting  the  individual  by  a  letter,  written  in  a  neutral,  nonaccu- 
satory  manner,  which  advises  of  the: 

(A)  Information  received  from  lEVS. 

(B)  Potential  impact  on  eligibility  or  share  of  cost. 

(C)  Requirement  to  respond  within  10  days. 

(D)  Consequences  of  failure  to  respond  to  the  inquiry,  as  specified  in 
Section  50175. 

(2)  Referring  the  case  to  the  Department  for  investigation  in  accor- 
dance with  procedures  established  by  the  Department. 

NOTE:  Authority  cited:  Sections  10725,  10740  and  14124.5,  Welfare  and  Institu- 
tions Code.  Reference:  Secfions  1 1004,  1 1025, 14001, 1401 1  and  14014,  Welfare 
and  Institutions  Code;  and  42  Code  of  Federal  Regulations  435.955. 

History 

1.  New  section  filed  7-16-87;  operative  7-16-87  pursuant  to  Government  Code 
Section  1 1346.2(d)  (Register  87,  No.  30). 

§  501 68.    Verification— Within  60  Days. 

(a)  With  regard  to  information  on  the  Statement  of  Facts,  the  county 
department  shall  obtain  verification  of  the  following  items  in  the  manner 
specified  below,  within  60  days  of  the  date  of  initial  application,  but  not 
necessarily  prior  to  approval  of  eligibility: 

(1)  Social  Security  Numbers  (SSNs)  shall  be  submitted  through  the 
lEVS  to  the  Social  Security  Administration  for  verification  in  accor- 
dance with  procedures  established  by  the  Department. 

(A)  SSN(s)  shall  be  confirmed  by  viewing  Social  Security  cards,  So- 
cial Security  Administration  form  series  OA-702.  Any  one  of  the  follow- 
ing shall  be  acceptable  if  the  Social  Security  card  is  not  available: 

1.  An  award  letter,  Medicare  card  or  a  check  from  the  Social  Security 
Administration  showing  the  applicant's  name  and  SSN  with  letters  A, 
HA,  J,  T  or  M  following  the  SSN. 

2.  Other  documentation  from  the  Social  Security  Administration  upon 
approval  by  the  Department. 

(B)  Application  for  an  SSN  or  evidence  of  an  SSN  shall  be  confirmed 
by  viewing  Social  Security  Administration  district  office  notification 
that  application  for  an  SSN  or  evidence  of  an  SSN  has  been  made. 


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Register  96,  No.  47;  11-22-96 


§  50169 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


(b)  Medicare  eligibility  shall  be  verified  by  viewing  a  Health  Insur- 
ance Card,  form  SSA-1966,  an  award  letter  showing  the  individual's 
Health  Insurance  Claim  number  (HIC),  an  Explanation  of  Medicare 
Benefits  (EOMB)  issued  by  the  Medicare  fiscal  intermediary,  or  a  bill  for 
Premium  Part  A  or  Part  B,  form  SSA  1545  or  1545A. 

(c)  If  a  person  or  family  receives  a  Medi-Cal  card  prior  to  verification 
of  an  HIC  number,  SSN,  application  for  an  SSN  or  evidence  of  an  SSN, 
and  that  verification  is  not  completed  within  the  time  limit  for  reasons 
within  the  beneficiary's  control: 

( 1 )  Eligibility  no  longer  exists  and  the  person  shall  be  discontinued.  In 
family  situations  only  the  person  or  persons  whose  number  is  not  verified 
shall  be  discontinued. 

(2)  Eligibility  shall  not  be  reapproved  until  the  required  evidence  is 
submitted. 

NOTE:  Authority  cited:  Sections  10725,  10740  and  14124.5,  Welfare  and  Institu- 
tions Code;  and  Section  57,  Chapter  328.  Statutes  of  1982.  Reference:  Sections 
11004,  14001  and  1401 1,  Welfare  and  Institutions  Code;  and  42  Code  of  Federal 
Regulations  435.910(g). 

History 

1.  Amendment  of  subsections  (a)  and  (b)  filed  12-15-77;  effective  thirtieth  day 
thereafter  (Register  77,  No.  51). 

2.  Amendment  of  subsections  (a)  and  (c)  and  new  subsection  (d)  filed  4-9-80;  ef- 
fective thirtieth  day  thereafter  (Register  80,  No.  15). 

3.  Amendment  filed  1-8-81 ;  effective  thirtieth  day  thereafter  (Register  81,  No.  2). 

4.  Amendment  filed8-18-82  as  an  emergency;  effective  upon  filing  (Register  82, 
No.  34).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  12-16-82. 

5.  Certificate  of  Compliance  transmitted  to  OAL  12-14-82  and  filed  1-21-83 
(Register  83,  No.  4). 

6.  Editorial  correction  of  subsection  (a)(1)(C)  filed  7-7-83  (Register  83,  No.  29). 

7.  Amendment  filed  7-16-87;  operative  7-16-87  pursuant  to  Government  Code 
Section  1 1346.2(d)  (Register  87,  No.  30). 

§  50169.    Additional  Verification  Requirements. 

(a)  The  county  department  shall  not  require  verification  of  informa- 
tion, other  than  the  verification  specified  in  these  regulations,  unless  the 
county  department  considers  the  verification  necessary  to  ensure  a  cor- 
rect eligibility  determination  in  the  specific  case. 

(b)  The  need  for  in-home  supportive  services  as  determined  under  the 
IHSS  program  pursuant  to  the  standards  and  procedures  established  for 
that  program,  DSS  Manual  of  Policies  and  Procedures,  division  30,  sec- 
tions 30-700  through  30-775,  shall  be  verified  prior  to  the  application 
of  the  deduction  specified  in  section  50551.6.  Such  determination  and 
verification  shall  be  limited  to  the  type  and  amount  of  services  needed. 
The  payment  for  IHSS  services  shall  be  verified  by  viewing  cancelled 
checks,  or  receipts  signed  by  the  provider  of  service. 

(c)  The  county  department  shall  document  in  the  case  file  the  type  of 
verification  obtained  when  verification  is  required  under  (a)  or  (b)  or  un- 
der sections  50167  and  50168. 

(d)  The  following  items  shall  be  verified  at  each  redetermination,  res- 
toration or  reapplication. 

(1)  Incapacity. 

(2)  Legal  responsibility  for  a  child  applying  alone. 

(3)  Refusal  of  the  parent  to  apply  for  an  18  to  21  year  old  child. 

(4)  Income,  except  income  received  from  the  United  States  govern- 
ment which  has  previously  been  verified  in  accordance  with  the  provi- 


sions of  sections  501 67(a)(7)(A)  1.  through  5.  or  for  which  verification 
has  been  obtained  from  the  appropriate  government  agency. 

(5)  Status  and  value  of  nonexempt  property. 

(6)  The  continuing  need  for  IHSS  services. 

(7)  Immigration  status;  provided,  however,  that  the  county  department 
shall  not  require  or  request  an  applicant  for  or  a  beneficiary  of  restricted 
Medi-cal  benefits  to  disclose  their  citizenship  or  immigration  status, 
birthplace,  country  of  citizenship,  alien  registration  number  and/or  alien 
admission  number,  date  of  first  entry  into  the  United  States,  or  name  upon 
first  entry  into  the  United  States. 

(e)  County  departments  shall  verify  the  immigration  status  of  all  alien 
applicants  for  full  Medi-Cal  benefits  and  of  persons  applying  for  re- 
stricted Medi-Cal  benefits  who  indicate  they  are  amnesty  aliens. 

(f)  The  following  items  shall  be  verified  whenever  there  is  a  change: 

(1)  Blindness. 

(2)  Disability. 

(3)  Immigration  status;  provided,  however,  that  the  county  department 
shall  not  require  or  request  an  applicant  for  or  a  beneficiary  of  restricted 
Medi-cal  benefits  to  disclose  their  citizenship  or  immigration  status, 
birthplace,  country  of  citizenship,  alien  registration  number  and/or  alien 
admission  number,  date  of  first  entry  into  the  United  States,  or  name  upon 
first  entry  into  the  United  States. 

(4)  SSN;  provided,  however,  that  the  county  department  shall  not  re- 
quire or  request  an  applicant  for  or  a  beneficiary  of  restricted  Medi-cal 
benefits  to  disclose  whether  they  have  a  Social  Security  Number  or  what 
that  number  is. 

(5)  HIC  number. 

(6)  A  change  in  residency  shall  be  verified  whenever  one  of  the  follow- 
ing conditions  exists: 

(A)  The  applicant  or  beneficiary  is  absent  from  the  state  for  less  than 
60  days  and  claims  to  be  a  resident  of  California,  and  the  county  has  evi- 
dence to  the  contrary  pursuant  to  SecUon  50321(a). 

(B)  The  apphcant  or  beneficiary  is  absent  from  the  state  for  more  than 
60  days  and  claims  to  meet  the  conditions  of  Section  50323  for  maintain- 
ing California  residency. 

(g)  The  following  procedures  shall  apply,  for  persons  who  were  deter- 
mined eligible  prior  to  the  effective  date  of  this  subsection  and  who  have 
not  submitted  an  SSN,  at  the  time  of  the  next  redetermination,  restoration 
or  reapplication: 

(1)  Section  50168(a)(1)  shall  apply  when  a  face-to-face  interview  is 
required. 

(2)  Persons  for  whom  a  face-to-face  interview  is  not  required  shall 
submit  an  SSN,  or  evidence  of  application  for  an  SSN,  within  60  days. 

(h)  Certification  for  Medi-Cal  shall  not  be  delayed  or  discontinued 
pending  receipt  of  verification  from  a  person  who  is  currently  eligible  un- 
less the  beneficiary  refuses  to  cooperate. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code;  Section  2,  Chapter  364,  Statutes  of  1 984;  and  Section  9,  Chapter  1441 ,  Stat- 
utes of  1988.  Reference:  Secfions  14005.14,  14007.5  and  14011,  Welfare  and  In- 
stitutions Code;  and  the  Crespin  v.  Kizer  court  order  (Alameda  County  Superior 
Court,  December  16,  1992). 

History 

1.  Amendment  of  subsections  (d)  and  (e),  and  reletteringof  subsecdons  (e),  (f)  and 
(g)  filed  1 1-14-89  as  an  emergency  pursuant  to  secfion  9  of  chapter  1441  of  the 
Statutes  of  1988;  operative  1 1-14-89  (Register  89,  No.  48).  A  Certificate 


Page  330 


Register  96,  No.  47;  11-22-96 


Title  22 


Health  Care  Services 


§  50175 


of  Compliance  must  be  transmitted  to  OAL  within  1 20  days  or  emergency  lan- 
guage will  be  repealed  on  3-14-90.  For  prior  histoi^,  see  Register  85,  No.  43. 

2.  Amendment  of  subsections  (d)  and  (e),  and  relettering  of  subsections  (e),  (f)  and 
(g)  refiled  3-8-90  as  an  emergency  pursuant  to  section  9  of  chapter  1441  of  the 
Statutes  of  1988;  operative  3-13-90  (Register  90.  No.  12).  A  Certificate  of 
Compliance  must  be  transmitted  to  OAL  within  120  days  or  emergency  lan- 
guage will  be  repealed  on  7-1 1-90. 

3.  Certificate  of  Compliance  as  to  3-8-90  order  transmitted  to  OAL  7-05-90  and 
disapproved  8-6-90  (Register  90,  No.  42). 

4.  Amendment  filed  8-23-90  as  an  emergency  pursuant  to  section  9  of  chapter  441 
of  the  Statutes  of  1988;  operafive  8-23-90  (Register  90.  No.  42).  A  Certificate 
of  Compliance  must  be  transmitted  to  OAL  by  12-21-90  or  emergency  lan- 
guage will  be  repealed  by  operation  of  law  on  the  following  day. 

5.  Certificate  of  Compliance  as  to  8-23-90  order  transmitted  to  OAL  1 1-20-90 
and  filed  12-17-90  (Register  91,  No.  5). 

6.  New  subsections  (f)(6)-(f)(6)(B)  and  amendment  of  subsections  (d)(7),  (f)(3), 
(f)(4)  and  Note  filed  5-17-93  as  an  emergency  with  Secretary  of  State  by  the 
Department  of  Health  Services;  operative  5-17-93.  Submitted  to  OAL  for 
printing  only  pursuant  to  1992  Senate  Bill  485  (Register  93,  No.  21). 

§  501 71 .    Clarification  of  Statement  of  Facts. 

(a)  All  information  provided  on  the  Statement  of  Facts  other  than  that 
verified  in  accordance  with  Sections  50167,  50168  and  50169  shall  be 
accepted  as  a  basis  for  determination  of  eligibility  and  share  of  cost,  un- 
less the  Statement  of  Facts  is  unclear  or  inconsistent. 

(b)  If  additional  clarification  is  needed,  the  county  department  shall  in- 
form the  person  who  signed  the  Statement  of  Facts  of  the  information 
needed  and  the  reason  for  the  request.  Such  persons  shall  be  responsible 
for  securing  the  additional  information. 

(c)  If  the  person  who  signed  the  Statement  of  Facts  has  difficulty  in  se- 
curing the  necessary  information,  the  county  department  shall,  with  the 
person's  written  consent,  obtain  the  information.  The  Applicant  Authori- 
zation for  Release  of  Information  form  shall  identify  persons  to  be  con- 
tacted and  the  specific  information  to  be  requested. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  11004,  11050,  14001  and  14011,  Welfare  and  Institu- 
tions Code. 

History 

1.  Amendment  of  subsection  (b)  and  new  subsection  (c)  filed  12-15-77;  effective 
thirtieth  day  thereafter  (Register  77,  No.  51). 

2.  Editorial  con-ection  of  subsection  (c)  filed  7-7-83  (Register  83,  No.  29). 

§50172.    Verification  by  Signature. 

(a)  The  signature  on  the  Statement  of  Facts  shall  be  accepted  as  verifi- 
cation of  the  facts  if  both  of  the  following  conditions  are  met,  except  as 
specified  in  (c): 

(1)  The  information  required  for  establishing  eligibility  under  these 
regulations  is  not  available. 

(2)  The  county  department  determines  that  the  information  provided 
on  the  Statement  of  Facts  is  sufficient  to  determine  eligibility.  If  the  infor- 
mation on  the  Statement  of  Facts  is  insufficient,  the  county  department 
shall  accept  a  signed  statement,  from  the  person  completing  the  State- 
ment of  Facts,  providing  the  necessary  supplemental  information. 

(b)  The  county  department  shall  state  on  the  Statement  of  Facts  that 
this  is  the  only  method  of  verification  available,  if  this  method  of  verifica- 
tion is  used. 

(c)  The  signature  on  the  Statement  of  Facts  shall  not  be  accepted  as 

verification  of  a  person's  SSN,  application  for  an  SSN  or  for  evidence  of 

an  SSN. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14011,  Welfare  and  Institutions  Code. 

History 

1 .  New  section  filed  12-1 5-77;  effective  thirtieth  day  thereafter  (Register  77,  No. 
51). 

2.  Amendment  of  subsection  (a)  and  new  subsection  (c)  filed  4-9-80;  effective 
thirtieth  day  thereafter  (Register  80,  No.  15). 

§  50173.     Eligibility  Determination. 

(a)  The  county  department  shall  determine  the  person' s  or  family' s  eli- 
gibility and  share  of  cost  after  the  applicant  for  Medi-Cal  has  applied, 
completed  the  Statement  of  Facts,  and  provided  all  essential  information. 


Tlie  eligibility  and  share  of  cost  deterinination  shall  be  completed  in  the 
following  manner: 

(1 )  Those  persons  whose  eligibility  is  being  determined  as  Other  PA 
recipients  shall  have  their  eligibility  determined  in  accordance  with  the 
regulations  and  procedures  governing  the  program  to  which  they  are 
linked  and  any  other  requirements  applicable  to  their  aid  category,  as  spe- 
cified in  sections  50237  through  50247. 

(2)  Those  persons  whose  eligibility  is  being  determined  as  MN  or  MI 
shall  have  their  ehgibility  and  share  of  cost  determined  in  accordance 
with  articles  4  through  13  (commencing  with  section  50141). 

(b)  A  determination  based  on  the  results  of  a  county  search  for  infor- 
mation under  section  50166  shall  be  completed  in  the  same  manner  as 
any  other  determination. 

(1)  Only  the  income  and  resources  discovered  through  the  search  shall 
be  considered  available. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code:  and  Section  9,  Chapter  1441,  Statutes  of  1988.  Reference:  Sections  1 1054, 
14000,  14001,  14007.5  and  1401 1,  Welfare  and  Institufions  Code. 

History 

1.  New  subsection  (b)  filed  5-30-79  as  an  emergency;  designated  effecfive 
6-1-79  (Register  79,  No.  22). 

2.  Certificate  of  Compliance  filed  9-19-79  (Register  79,  No.  38). 

3.  Amendment  of  subsection  (b)  filed  1 1-14-89  as  an  emergency  pursuant  to  sec- 
tion 9  of  chapter  1441  ofthe  Statutes  of  1988;  operative  1 1-14-89  (Register  89, 
No.  48).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  3-14-90. 

4.  Amendment  of  subsection  (b)  refiled  3-8-90  as  an  emergency  pursuant  to  sec- 
tion 9  of  chapter  1441  ofthe  Statutes  of  1988;  operative  3-13-90  (Register  90, 
Nfo.  12).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  7-1 1-90. 

5.  Certificate  of  Compliance  as  to  3-8-90  order  transmitted  to  OAL  7-5-90  and 
disapproved  8-6-90  (Register  90,  No.  42). 

6.  Amendment  of  subsection  (b)  filed  8-23-90  as  an  emergency  pursuant  to  sec- 
tion 9  of  chapter  1441  ofthe  Statutes  of  1988;  operative  8-23-90  (Register  90, 
No.  42).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  12-21-90 
or  emergency  language  will  be  repealed  by  operation  of  law  on  the  following 
day. 

7.  Certificate  of  Compliance  as  to  8-23-90  order  transmitted  to  OAL  1 1-20-90 
and  filed  12-17-90  (Register  91,  No.  5). 

§  50175.    Denial  or  Discontinuance  Due  to  Lack  of 
Information,  Noncooperation  or  Loss  of 
Contact. 

(a)  The  application  shall  be  denied  or  eligibility  shall  be  discontinued 
under  any  of  the  following  circumstances: 

(1)  There  is  insufficient  information  available  to  make  an  eligibility 
determination,  after  the  county  department  has  made  a  reasonable  effort 
to  obtain  the  necessary  information. 

(2)  The  applicant  or  person  completing  the  Statement  of  Facts  fails, 
without  good  cause,  to  provide  necessary  verification  or  to  cooperate 
with  the  county  department  in  resolving  incomplete,  inconsistent  or  un- 
clear information  on  the  Statement  of  Facts. 

(3)  The  beneficiary  fails,  without  good  cause,  to  return  a  status  report 
required  under  Section  50191  (a)  or  (b). 

(4)  The  applicant  or  beneficiary  fails,  without  good  cause,  to  partici- 
pate in  the  face-to-face  interview  in  accordance  with  Section  50157. 

(5)  The  applicant  or  beneficiary  fails,  without  good  cause,  to  respond 
within  10  days  to  a  letter  from  the  county  department  idenfifying  infor- 
mation received  from  the  lEVS  and  requesting  further  information. 

(6)  The  county  department,  after  reasonable  attempts  to  contact  the 
applicant  or  beneficiary,  determines  that  there  is  loss  of  contact. 

(7)  The  applicant  or  beneficiary; 

(A)  Refuses  to  assign  to  the  state  all  rights  to  medical  support  and  pay- 
ments as  specified  in  Section  50185(a)(ll). 

(B)  Fails  to  cooperate  with  the  state,  county  department,  and  the  dis- 
trict attorney's  office,  without  good  cause,  as  specified  in  Section 
50771.5  in: 

1.  Providing  information  to  establish  paternity  for  a  child  under  eigh- 
teen years  of  age  bom  out  of  wedlock  for  whom  Medi-Cal  is  requested; 

2.  Obtaining  medical  support  and  payments;  and 


Page  331 


Register  97,  No.  37;  9-12-97 


§  50176 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


3.  Identifying  and  providing  information  to  assist  the  state,  county,  or 
district  attorney  in  pursuing  any  third  party  who  is  or  may  be  liable  to  pay 
for  medical  care,  services,  or  support. 

In  the  case  of  a  refusal  to  assign  rights  or  to  cooperate  in  (B)  above,  the 
parent  or  caretaker  relative  will  be  given  the  opportunity  to  withdraw  his/ 
her  application.  Refusal  to  withdraw  the  application  shall  result  in  his/her 
ineligibility  as  specified  in  Section  50379. 

(b)  A  person  or  family  whose  eligibility  is  denied  or  discontinued  for 
any  of  the  reasons  specified  in  (a)  may: 

(1)  Reapply  at  any  time,  including  the  original  month  of  application. 

(2)  Have  the  denial  or  discontinuance  rescinded  by  providing  evidence 
that  the  person  or  family  had  good  cause  for  not  meeting  the  conditions 
specified  by  the  county  department. 

(c)  For  purposes  of  this  section  good  cause  includes,  but  is  not  limited 
to: 

(1)  Failure  of  the  county  to  provide  the  beneficiary  with  the  required 
status  report  form  or  with  the  information  that  failure  to  complete  and  re- 
turn the  form  may  result  in  discontinuance. 

(2)  Failure  of  the  postal  system  to  deliver  the  required  status  report 
forms  in  a  timely  manner. 

(3)  Physical  or  mental  illness  or  incapacity  of  the  beneficiary  and  the 
authorized  representative  which  precludes  their  completion  or  return  of 
the  completed  status  report  form  in  a  timely  manner,  or  which  precludes 
their  participation  in  the  face-to-face  interview. 

(4)  A  level  of  literacy  of  the  beneficiary  and  the  authorized  representa- 
tive which,  in  conjunction  with  other  social  or  language  barriers,  pre- 
cludes the  beneficiary  and  the  authorized  representative  from  completing 
the  status  report. 

(5)  Failure  of  the  county  to  process  properly  the  submitted  Statement 
of  Facts  or  status  report  form. 

(6)  Unavailability  of  transportation  to  the  county  department  for  the 
face-to-face  interview. 

(7)  A  determination  by  the  county  department  that  the  applicant  or 
beneficiary  (1)  failed  to  cooperate  in  obtaining  medical  support  and  pay- 
ments for  himself/herself  and  for  any  other  individual  for  whom  he/she 
is  applying;  in  identifying  and  providing  information  to  assist  the  state, 
county,  and/or  district  attorney  in  pursuing  any  third  party  who  is  or  may 
be  liable  to  pay  for  medical  care,  services,  and  support;  and  in  establish- 
ing paternity,  but  (2)  met  the  good  cause  criteria  specified  in  Section 
50771.5. 

NOTE:  Authority  cited:  Sections  10725, 10740  and  14124.5,  Welfare  and  Institu- 
tions Code.  Reference:  Sections  11004,  11050,  14001,  14008.6,  14011,  14012, 
14014  and  14016,  Welfare  and  Institutions  Code;  and  42  Code  of  Federal  Regula- 
tions 435.955(c)(2);  and  42  C.F.R.  Sections  433. 135. 433. 136, 433. 137,  433.138, 
433.145,  433.146,  433.147,  433.148  and  435.604. 

History 

1.  Amendment  of  subsection  (b)  filed  12-15-77;  effective  thirtieth  day  thereafter 
(Register  77,  No.  51). 

2.  Amendment  filed  9-1-78;  effective  thirtieth  day  thereafter  (Register  78,  No. 

35). 

3.  Editorial  correction  of  Note  filed  7-7-83  (Register  83,  No.  29). 

4.  Amendment  of  subsection  (a)  filed  7-16-87;  operative  7-16-87  pursuant  to 
Government  Code  Section  1 1346.2(d)  (Register  87,  No.  30). 

5.  New  subsections  (a)(7)-(a)(7)(B)3.  and  (c)(7),  and  amendment  of  subsecfions 
(a),  (c)(5)  and  Note  filed  4-16-93  as  an  emergency;  operative  4-16-93  (Regis- 
ter 93,  No.  16).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL 
8-16-93  or  emergency  language  will  be  repealed  by  operation  of  law  on  the  fol- 
lowing day. 

6.  Certificate  of  Compliance  as  to  4-16-93  order  including  amendment  of  Note 
U-ansmitted  to  OAL  8-13-93  and  filed  9-23-93  (Register  93,  No.  39). 

§  50176.    Discontinuance  Due  to  Death. 

Eligibility,  shall  be  discontinued  at  the  end  of  the  month  in  which  a  per- 
son dies. 

§  50177.    Promptness  Requirement. 

(a)  The  county  department  shall  complete  the  determination  of  eligi- 
bility and  share  of  cost  as  quickly  as  possible  but  not  later  than  any  of  the 
following: 


(1)  Forty-five  days  following  the  date  the  application,  reapplication 
or  request  for  restoration  is  filed. 

(2)  Ninety  days  following  the  date  the  apphcation,  reapplication  or  re- 
quest for  restoraUon  is  filed  when  eligibility  depends  on  establishing  dis- 
ability or  blindness. 

(b)  The  45-  and  90-day  periods  may  be  extended  for  any  of  the  follow- 
ing reasons: 

(1)  The  applicant,  the  applicant's  guardian,  or  other  person  acUng  on 
the  apphcant's  behalf,  has  for  good  cause,  been  unable  to  return  the  com- 
pleted Statement  of  Facts,  Supplement  to  Statement  of  Facts  for  Retroac- 
tive Coverage/Restoration,  or  necessary  verification  in  time  for  the 
county  department  to  meet  the  promptness  requirement. 

(2)  There  has  been  a  delay  in  the  receipt  of  reports  and  information 
necessary  to  determine  eligibility  and  the  delay  is  beyond  the  control  of 
either  the  applicant  or  the  county  department. 

(c)  The  determination  of  eligibility  shall  be  considered  complete  on 
the  date  the  Notice  of  Action  is  mailed  to  the  applicant. 

NOTE:  Authority  cited:  Sections  10725,  14124.5  and  14154.2(b),  Welfare  and  In- 
stitufions  Code.  Reference:  Sections  11052,  11055,  14001,  14011,  14016.  and 
14154.2(b)  Welfare  and  Insfitutions  Code;  and  42  Code  of  Federal  Regulations 
435.911. 

History 

1 .  Amendment  of  subsection  (b)(  I)  filed  12- 1 5-77;  effective  thirtieth  day  thereaf- 
ter (Register  77,  No.  51). 

2.  Amendment  filed  8-7-78;  effective  thirtieth  day  thereafter  (Register  78,  No. 

32). 

3.  Amendment  of  subsection  (b)  filed  3-7-80  as  an  emergency;  effecfive  upon  fil- 
ing (Register  80,  No.  9).  A  Certificate  of  Compliance  must  be  transmitted  to 
OAH  within  120  days  or  emergency  language  will  be  repealed  on  7-6-80. 

4.  Certificate  of  Compliance  filed  6-6-80  (Register  80,  No.  23). 

5.  Editorial  correction  of  NOTE  filed  7-7-83  (Register  83,  No.  29). 

6.  Change  without  regulatory  effect  filed  1-9-91  pursuant  to  section  100,  title  1, 
California  Code  of  Regulations  (Register  91,  No.  8). 

§  50179.    Notice  of  Action — IVIedi-Cal-Only  Determinations 
or  Redeterminations. 

(a)  County  departments  shall  nofify  beneficiaries  in  writing  of  their 
Medi-Cal-only  eligibility  or  ineligibility,  and  of  any  changes  made  in 
their  eligibility  status  or  share  of  cost.  This  notification  shah  be  called  the 
"Notice  of  Action." 

(b)  The  Nouce  of  Action  shall  be  on  a  form  prescribed  by  the  Depart- 
ment and  shall  include  the  name  and  telephone  number  of  the  eligibility 
worker  who  completed  the  eligibility  deterinination,  and  the  date  the 
form  was  completed.  A  copy  of  the  Notice  of  Action  shall  be  placed  in 
the  case  file. 

(c)  The  Notice  of  Acfion  shall  include  the  following: 

(1)  The  approval,  denial  or  discontinuance  of  eligibility,  the  recision 
of  a  denial  or  discontinuance,  or  the  change  in  the  share  of  cost  and  the 
effective  date  of  the  action. 

(2)  The  amount  of  the  share  of  cost,  if  any,  and  the  amount  of  the  net 
nonexempt  income  used  to  determine  the  share  of  cost. 

(3)  The  reason  an  acfion  is  being  taken  and  the  law  or  regulation  that 
requires  the  action,  if  the  action  is  a  denial,  disconfinuance  or  increase  in 
share  of  cost. 

(4)  The  right  to  request  a  State  hearing  if  dissatisfied  with: 

(A)  Any  acfion  or  inacfion  by  the  county  department  that  affects  the 
applicant's  or  beneficiary's  Medi-Cal  eligibility  or  share  of  cost,  except 
as  fimited  in  Secfion  50951(a). 

(B)  Any  action  taken  by,  or  on  behalf  of,  the  Department  that  affects 
the  applicant's  or  beneficiary's  Medi-Cal  benefits. 

(5)  The  procedures  for  requesting  a  State  hearing  and  the  time  limits 
within  which  a  state  hearing  must  be  requested. 

(6)  The  circumstances  under  which  aid  will  be  continued  if  a  hearing 
is  requested. 

(7)  A  statement,  when  appropriate,  regarding  the  information  or  action 
necessary  to  reestablish  eligibility  or  determine  a  correct  share  of  cost. 

(d)  The  Notice  of  Action  shall  be  mailed  for: 


Page  332 


Register  97,  No.  37;  9-12-97 


Title  22 


Health  Care  Services 


§  50183 


(1)  Adverse  actions,  at  least  10  calendar  days  prior  to  the  first  of  the 
month  in  which  the  action  becomes  effective,  excluding  the  date  of  mail- 
ing- 

(2)  Discontinuances  or  increases  in  the  share  of  cost  which  are  not  ad- 
verse actions,  in  sufficient  time  to  reach  the  beneficiary  by  the  effective 
dale  of  the  action. 

(3)  All  other  instances,  no  later  than  the  date  the  county  department 
takes  the  action. 

(e)  Duplicate  Notices  of  Action  shall  be  mailed  to  the  administrator  of 
the  long-term  care  facility  in  which  the  applicant  or  beneficiary  resides, 
if  the  applicant  or  beneficiary  or  person  acting  on  their  behalf  has  made 
such  a  request. 

(f)  Conditional  notices,  which  advise  applicants  or  beneficiaries  that 
ehgibility  will  be  denied  or  discontinued  unless  specified  actions  are  tak- 
en by  the  applicants  or  beneficiaries,  shall  not  be  considered  to  meet  the 
Notice  of  Action  requirements  of  (a). 

Note.  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  10950,  10951,  11002,  11004,  11052,  11055,  14000, 
14005,  14016,  14016.2,  14023,  14023.7  and  14124.90  Welfare  and  Institutions 
Code. 

History 

1 .  Amendments  of  subsections  (a)  and  (c)  filed  6-28-89;  operative  7-28-89  (Reg- 
ister 89,  No.  26).  For  prior  history,  see  Register  8 1 ,  No.  2 1 . 

2.  Amendment  of  subsection  (c)(1),  repealer  of  subsections  (c)(4)-(c)(7),  and  sub- 
section renumbering  filed  9-10-97;  operative  10-10-97  (Register97,  No.  37). 


§  501 79.5.     Notice  of  Action— County  Cash  Assistance 
Determinations  or  Redeterminations  Which 
Affect  County  Cash-Based  l\/ledi-Cal  Eligibility. 

(a)  Persons  who  are  granted,  denied  or  discontinued  from  county 
cash-based  programs  shall  be  notified  by  the  county  department,  in  writ- 
ing, of  their  eligibility  or  ineligibility  for  county  cash-based  Medi-Cal. 
Additionally,  persons  who  are  discontinued  shall  be  notified  of  their  con- 
tinued Medi-Cal  eligibility  status  in  accordance  with  (c). 

(b)  The  form  of  notification  shall  be  one  of  the  following: 

(1 )  The  appropriate  Notice  of  Action  prescribed  by  the  Department  of 
Social  Services,  if  the  notification  regarding  Medi-Cal  eligibility  does 
not  affect  the  adequacy  of  timeliness  of  the  cash  assistance  or  IHSS  no- 
tice. 

(2)  A  Medi-Cal  Notice  of  Action,  if  the  notification  regarding  Medi- 
Cal  eligibility  would  affect  the  adequacy  of  timeliness  of  the  cash  assis- 
tance or  IHSS  notice. 

(c)  A  Notice  of  Action  of  discontinuance  of  county  cash-based  Medi- 
Cal  shall  include  notice  that  one  of  the  following  actions  has  been  taken: 

(1)  A  referral  for  determination  of  Medi-Cal  eligibility  under  another 
program  is  being  made  and  notification  of  that  determination  will  follow. 

(2)  A  Medi-Cal-only  determination  has  been  made  and  the  specific 
results  of  that  determination. 

(3)  County  cash-based  Medi-Cal  is  being  discontinued  for  one  of  the 
reasons  stated  in  Section  50183  and  a  determination  of  Medi-Cal-only 
eligibility  will  require  a  separate  application. 

(4)  A  cash  grant  or  IHSS  is  being  discontinued  due  to  failure  of  the  re- 
cipient to  submit  data  on  current  status,  via  Monthly  AFDC  Eligibility 
and  Income  Report  form  or  another  approved  method.  An  automatic  re- 
evaluation  of  Medi-Cal  eligibility  under  any  program  will  be  done  only 
if  the  data  is  provided  by  the  effective  date  of  the  notice. 

(5)  Additional  information  is  required  to  permit  completion  of  a  Medi- 
Cal-only  determination.  The  information  required  may  include  the  per- 
son's wishes  concerning  continued  Medi-Cal  eligibility.  The  county  de- 
partment may  require  that  the  person  provide  the  information  by  a 
specific  date. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  11004,  Welfare  and  Institutions  Code. 

History 

1.  New  section  filed  3-5-81;  effective  thirtieth  day  thereafter  (Register  81,  No. 
10). 

2.  Editorial  correction  of  subsection  (c)(4)  filed  7-7-83  (Register  83,  No.  29). 


§  50179.7.     Notice  of  Action— Medi-Ca!  Eligibility  of 
SSI/SSP  Recipients. 

(a)  The  Department  of  Health  Services  shall  notify  persons  deter- 
mined to  be  eligible  for  SSI/SSP  by  the  Social  Security  Administration 
that  they  are  also  eligible  for  Medi-Cal. 

(b)  The  Department  of  Health  Services  shall  notify  persons  whose 
Medi-Cal  eligibility  has  been  discontinued  by  the  Department  pursuant 
to  Section  50183.5  that  their  public  assistance  Medi-Cal  eligibility  has 
been  discontinued  and  that  the  county  department  will  contact  them  to 
assist  them  with  the  completion  of  a  Medi-Cal-only  application. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Secfions  1 1004  and  14016,  Welfare  and  Institutions  Code. 

History 

1 .  New  section  filed  4-13-81;  effective  thirtieth  day  thereafter  (Register  81,  No. 
16). 

§  50180.    Action  Prior  to  Denial  of  Application. 

Persons  or  families  denied  Medi-Cal  eligibility  under  any  program 
other  than  SSI/SSP  shall  have  their  circumstances  evaluated  by  the 
county  department  prior  to  denial.  If  it  appears  that  eligibility  would  exist 
under  any  program  other  than  SSI/SSP,  the  application  shall  be  processed 
under  that  program.  The  date  of  application  shall  be  the  date  of  the  origi- 
nal application. 

§  501 81 .    Action  Following  Denial  of  an  SSI/SSP 
Application. 

(a)  Persons  denied  SSI/SSP  eligibility,  who  then  apply  for  Medi-Cal 
at  the  county  department,  shall  have  their  application  processed  under  the 
appropriate  program.  The  date  of  application  shall  be: 

(1)  The  date  of  the  original  application  for  SSI/SSP  for  those  persons 
who  apply  at  the  county  department  within  30  days  of  receipt  of  a  written 
notice  of  denial  of  SSI/SSP  benefits. 

(2)  The  date  the  person's  completed  application  form  is  received  by 
the  county  department  for  those  persons  who  do  not  apply  at  the  county 
department  within  the  30-day  period  specified  in  (1). 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  1 1057, 14001, 14005.4and  14005.7,  Welfare  and  Insti- 
tufions  Code. 

History 
1.  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50182.    Corrective  Action  on  Denied  Applications. 

(a)  A  denial  of  an  application  shall  be  rescinded  in  either  of  the  follow- 
ing situations: 

(1)  A  fair  hearing  decision  orders  such  action. 

(2)  The  county  department  determines  that  the  denial  was  in  error. 

(b)  Medi-Cal  eligibility  that  results  from  corrective  action  taken  on  a 
denied  application  shall  be  approved  based  on  the  date  of  the  application 
that  was  denied. 

§  50183.    Transfer  Between  Programs. 

(a)  A  person  or  family  who  has  been  receiving  Medi-Cal  under  any 
program  other  than  SSI/SSP  and  whose  eligibility  is  discontinued  shall 
be  evaluated  by  the  county  department  to  determine  if  Medi-Cal  eligibil- 
ity exists  under  any  other  program.  If  it  appears  that  eligibility  would  ex- 
ist for: 

(1)  AFDC  regulations  pertaining  to  the  appropriate  AFDC  program 
shall  be  followed  in  transferring  the  case  and  establishing  eligibility. 

(2)  SSI/SSP,  the  person  shall  be  referred  to  the  Social  Security  Admin- 
istration. This  referral  shall  be  documented  in  the  case  file.  Pending  the 
SSI/SSP  determination,  the  county  department  shall  determine  eligibility 
under  any  other  program  for  which  the  person  may  be  eligible. 

(3)  Only  Medi-Cal-only  the  county  department  shall  initiate  an  intra- 
program  status  change  or  interprogram  transfer  to  the  appropriate  aid 
category  and  shall  determine  eligibility  under  that  aid  category.  A  new 
application  form  is  not  required. 

(b)  The  county  shall  not  be  required  to  evaluate  Medi-Cal  eligibility 
under  another  program  when  a  beneficiary  has: 

(1)  Been  discontinued  due  to  any  of  the  following: 


Page  333 


Register  97,  No.  37;  9-12-97 


§  50183.5 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


(A)  A  move  out  of  state. 

(B)  A  move  with  loss  of  contact. 

(C)  Death. 

(2)  Established  Medi-Cal  eligibility  simultaneously  in  two  or  more 
different  counties  or  under  two  or  more  different  programs  or  identities, 
and  eligibility  was  discontinued  in  all  but  one  county  or  under  all  but  one 
program  or  identity. 

(3)  Been  discontinued  from  the  program  due  to  noncooperation  in  sup- 
plying information  needed  to  meet  cash  grant  or  IHSS  eligibility  require- 
ments, and  those  same  requirements  exist  for  all  Medi-Cal-only  pro- 
grams for  which  the  person  may  be  eligible. 

(c)  Persons  whose  SSl/SSP  eligibility  has  been  discontinued  may  ap- 
ply for  Medi-Cal  at  the  county  department. 

(J )  A  new  application  shall  be  completed,  unless  the  family  of  the  per- 
son discontinued  from  SSI/SSP  is  currently  receiving  Medi-Cal.  In  this 
case,  the  request  for  aid  shall  then  be  treated  as  a  request  to  add  a  family 
member  to  the  Medi-Cal  case. 

(2)  The  date  of  the  application  shall  be  the  date  the  completed  applica- 
tion form  is  received  by  the  county  department. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005  and  14016,  Welfare  and  Institutions  Code. 

History 

1 .  Amendment  of  subsections  (a)(1)  and  (b)(1)  filed  12-15-77;  effective  thirtieth 
day  thereafter  (Register  77,  No.  51). 

2.  Amendment  of  subsection  (a)(])  filed  8-7-78;  effective  thirtieth  day  thereafter 
(Register  78,  No.  32). 

3.  Amendment  filed  3-5-81;  effective  tliirtieth  day  thereafter  (Register  81,  No. 
10). 

4.  Editorial  correction  of  subsection  (a)(3)  filed  7-7-83  (Register  83,  No.  29). 

§  50183.5.    Action  Following  Medi-Cal  Discontinuance  by 
the  Department. 

(a)  The  Department  shall  inform  the  county  department  of  any  ABD 
person  whose  Medi-Cal  eligibility  as  an  SSI/SSP  PA  recipient  has  been 
discontinued  because  the  conditions  in  (1)(A)  and  (B)  exist. 

(1)  The  county  department  shall  contact  the  person  and  assist  the  per- 
son with  the  completion  of  an  application  for  Medi-Cal-only  pursuant 
to  Section  50147  when  the  following  conditions  exist. 

(A)  The  person  has  been  in  long-term  care  for  more  than  the  month 
of  admission  and  is  expected  to  remain  in  the  facility  for  at  least  30  days. 

(B)  The  person  has  nonexempt  monthly  gross  income  in  excess  of 
$44.90. 

(2)  The  county  department  shall  advise  the  Department  immediately 
that  an  inappropriate  referral  has  been  received  when  the  conditions  in 
(1)  do  not  exist. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  11004  and  14016,  Welfare  and  Institutions  Code. 

History 
1.  New  section  filed  4-13-81;  effective  thirtieth  day  thereafter  (Register  81,  No. 
16). 

§  50184.    Referral  for  Social  Services. 

(a)  The  county  department  shall  refer  a  person  or  family  for  social  ser- 
vices in  accordance  with  Department  procedures  if  it  appears  that  there 
is  a  need  for  such  services. 

(b)  A  referral  for  social  services  shall  also  be  made  for  the  following 
needs  related  to  the  CHDP  Program  unless  other  arrangements  have  been 
made  with  the  local  CHDP  Program: 

(1)  Assistance  in: 

(A)  Arranging  for  screening  services  for  persons  under  21  years  of  age 
under  the  CHDP  Program. 

(B)  Overcoming  fears  of  medical  treatment. 

(C)  Understanding  the  importance  of  preventive  health. 

(2)  Arranging  for  transportation,  child  care  or  other  services  to  enable 
the  individual  to  take  advantage  of  CHDP  benefits. 

(c)  The  county  department  shall  notify  all  applicants  who  are  pregnant, 
breastfeeding  or  postpartum  women  as  defined  in  Section 
50157(f)(5)(A)  or  parents/guardians  of  children  under  the  age  of  five  of 


the  availability  of  benefits  provided  by  the  Special  Supplemental  Food 
Program  for  Women,  Infants  and  Children  (WIC)  program  by  giving  the 
applicant  a  WIC  brochure. 

(1)  An  oral  explanation  of  WIC  benefits  shall  be  given  to  those  individ- 
uals who  are  unable  to  read. 

(2)  Referral  shall  be  made  to  the  WIC  program  if  there  appears  to  be 
aneed  for  such  services  forall  such  individuals,  as  specified  in  subsection 
(c)  above. 

(d)  The  Department  of  Health  Services,  no  less  frequently  than  annual- 
ly, shall  provide  written  notification  concerning  the  WIC  program  to  all 
Medi-Cal  beneficiaries  who  might  be  pregnant,  breastfeeding,  or  post- 
partum as  defined  in  Section  50157(f)(5)(A),  or  a  parent/guardian  of  a 
child  under  the  age  of  five. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  10001, 10051, 14000, 14001  and  14001.1,  Welfare  and 
Institutions  Code;  Title  42,  United  States  Code,  Sections  1396a(a)(]  1),  (51),  (52) 
and  (53);  Title  42,  Code  of  Federal  Regulafions,  Section  431.635;  and  Section 
1902(a)  of  the  Social  Security  Act. 

History 

1.  Editorial  correction  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

2.  New  subsections  (c)-(d)  and  amendment  of  NOTE  filed  8-22-96;  operative 
9-21-96  (Register  96,  No.  34). 


§  50185.    Applicants'  and  Beneficiaries'  General 
Responsibilities. 

(a)  As  a  condition  of  eligibility,  applicants  and  beneficiaries,  and  per- 
sons acting  on  behalf  of  such  applicants  or  beneficiaries,  shall: 

(1)  Complete  and  participate  in  the  completion  of  all  documents  re- 
quired in  the  application  process  or  in  the  determination  of  continuing  eli- 
gibility. 

(2)  Make  available  to  the  county  department  all  documents  needed  to 
determine  eligibility  and  share  of  cost,  as  specified  in  Sections  50167 
through  50172. 

(3)  Report  all  facts  that  are  pertinent  to  the  determination  of  eligibility 
and  share  of  cost. 

(4)  Report  the  following  facts  to  the  county  department  that  may  affect 
the  determination  of  eligibility  and  share  of  cost  within  10  calendar  days 
following  the  date  the  change  occurred: 

(A)  Change  of  address. 

(B)  Change  in  property  or  income. 

(C)  Change  in  family  composition. 

(D)  Change  in  other  health  care  coverage. 

(5)  The  requirement  to  report  to  the  county  department  and  to  any  pro- 
vider of  health  care  services  any  existing  contractual  or  other  legal  en- 
titlement to  other  health  care  coverage;  and,  to  fully  utilize  other  health 
care  coverage  before  using  Medi-Cal  benefits.  The  information  to  be  re- 
ported shall  include  the  name  of  the  other  health  care  coverage,  policy 
and  group  numbers,  and  termination  date,  if  available. 

(6)  Responsibility  to  report  to  the  county  department  the  availability 
of  any  option  to  obtain  other  health  care  coverage  through,  but  not  limited 
to,  the  beneficiary's  employer,  labor  union,  trust  fund,  spouse  or  parent 
and  to  provide  information  necessary  for  the  Department  to  determine  if 
it  would  be  cost  effective  for  the  Department  to  pay  the  premium  to  obtain 
or  continue  other  health  coverage. 

(7)  The  requirement  to  apply  for,  and/or  retain  any  available  other 
health  care  coverage  when  there  is  no  premium  cost  to  the  beneficiary. 
Compliance  with  this  requirement  shall  be  a  condition  of  coverage  for 
Medi-Cal  covered  benefits  to  the  party  responsible  for  the  acquisition  or 
continuance  of  such  health  care  coverage,  and  shall  not  interfere  with 
Medi-Cal  benefits  provided  to  the  remaining  family  unit. 

(8)  Cooperate  fully  in  any  investigation  that  may  be  required  for  quali- 
ty control. 

(9)  Report,  apply  for,  and  utilize  all  other  health  care  coverage  avail- 
able to  the  individual  or  family  group  in  accordance  with  Section  50763. 

(10)  Complete  Medi-Cal  status  reports  in  accordance  with  Section 
50191  (a)  or  (b). 


Page  334 


Register  97,  No.  37;  9-12-97 


Title  22 


Health  Care  Services 


§  50185.5 


(11)  Promptly  notify  the  county  department  which  initially  established 
Medi-Ca]  eligibility  of  any  changes  in  residence  from  one  county  to 
another  within  the  state  and  apply  for  a  redetermination  of  eligibility 
within  the  new  county  of  residence.  "Apply  for  a  redetermination  of  eli- 
gibility," as  used  in  this  section,  is  defined  as  any  clear  expression  to  the 
county  department,  whether  verbal  or  written,  that  the  beneficiary  is  liv- 
ing in  the  county  and  wishes  to  continue  receiving  Medi-Cal. 

(1 2)  Cooperate  with  the  state,  county  department,  and  the  district  attor- 
ney's office  in  all  of  the  following: 

(A)  Establishing  paternity  for  a  child  under  eighteen  years  of  age  born 
out  of  wedlock  for  whom  Medi-Cal  is  requested. 

(B)  Obtaining  medical  support  and  payments;  and 

(C)  Providing  all  of  the  information  requested  by  the  state,  county  de- 
partment, and  district  attorney's  office,  which  is  necessary  to  identify,  lo- 
cate, and  pursue  any  third  party,  including  an  absent  parent,  who  is  or 
may  be  liable  for  medical  care  and  services  or  support. 

( 13)  In  the  case  of  a  woman  who  is  pregnant,  or  a  child  who  was  born 
out  of  wedlock  or  whose  parent  is  absent  from  the  home,  at  the  conclusion 
of  the  60-day  postpartum  period: 

(A)  Complete  the  Child  Support  Questionnaire  (CA  2.1  Q  Support 
Questionnaire,  Revised  3/93),  the  Child/Spousal  and  Medical  Support 
Notice  and  Agreement  (CA  2.1  Notice  and  Agreement,  Revised  12/92), 
and  any  additional  forms  specified  in  the  district  attorney  and  approved 
by  the  Department  of  Health  Services; 

(B)  Appear  at  the  county  department  and  at  the  office  of  the  district  at- 
torney to  provide  information,  when  requested; 

(C)  Provide  to  the  county  department  and  to  the  district  attorney  all  in- 
formation which  is  relevant  to  the  case. 

(D)  Appear  as  a  witness  in  court  or  in  other  hearings  and  proceedings 
relating  to  (9)  and  (10)  above. 

(14)  Assign  to  the  state  all  rights  to  any  medical  support  and  to  pay- 
ments for  medical  care  from  any  third  party,  as  specified  in  Section 
50157. 

(b)  Applicants  and  recipients  whose  eligibility  is  determined  by  the 
Social  Security  Administration  shall,  as  a  condition  of  eligibility,  comply 
with  subsections  (a)(9),  (a)(10),  and  (a)(l  1)  above,  and  report  to  the  De- 
partment and  utilize  all  other  health  care  coverage  available  to  them  in 
accordance  with  Section  50763. 

(c)  If  the  Statement  of  Facts  has  been  completed  and  signed  by  some- 
one other  than  the  applicant  or  beneficiary,  the  responsibilities  stated  in 
(a)  and  (b)  shall  rest  with  that  person  as  well  as  with  the  applicant  or  bene- 
ficiary. 

(d)  The  county  shall  assist  the  applicant  or  beneficiary  as  necessary  in 
meeting  the  requirements  of  this  section. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  10740,  11004(a)  and  (b),  11053,  14001,  14008.6, 
1 40 1 1 , 1 40 1 6  and  1 4 1 00. 1 ,  Welfare  and  Institutions  Code ;  and  42  C.F.R.  Sections 
433.135,  433.136,  433.137,  433.138,  433.145,  433.146,  433.147,  433.148  and 
435.604. 

History 

1.  Amendment  of  subsection  (a)(2)  filed  12-15-77;  effective  thirtieth  day  thereaf- 
ter (Register  77,  No.  51). 

2.  New  subsection  (a)  (7)  filed  9-1-78;  effective  thirtieth  day  thereafter  (Register 
78,  No.  35). 

3.  New  subsection  (a)(8)  filed  6-14-84;  designated  effective  7-1-84  pursuant  to 
Government  Code  section  11346.2(d)  (Register  84,  No.  24). 

4.  Amendment  of  secfion  heading,  subsecdons  (a),  (a)(6)  and  (b)  and  Note  filed 
4-16-93  as  an  emergency;  operative  4-16-93  (Register  93,  No.  16).  A  Certifi- 
cate of  Compliance  must  be  transmitted  to  OAL  8-16-93  or  emergency  lan- 
guage will  be  repealed  by  operation  of  law  on  the  following  day. 

5.  Certificate  of  Compliance  as  to  4-16-93  order  including  amendment  of  Note 
transmitted  to  OAL  8-13-93  and  filed  9-23-93  (Register  93,  No.  39). 

6.  Amendment  of  subsection  (a)(4),  new  subsections  (a)(4)(A)-(a)(7),  and  subsec- 
tion renumbering  filed  9-10-97;  operative  10-10-97  (Register  97,  No.  37). 


§  50185.5.    Medi-Cal  Managed  Care  Plan  Assigned 
Enrollment  Prior  to  Two-Plan  Model 
Implementation  or  for  Geographic  Areas  Not 
Designated  for  Two-Plan  Model 
Implementation. 

(a)  This  section  applies  to  geographic  areas  specified  by  the  director, 
which  may  include  geographic  areas  designated  for  implementation  of 
the  two-plan  model  as  defined  in  section  53810(n)  prior  to  implementa- 
tion of  the  two-plan  model,  and  geographic  areas  not  designated  for  two- 
plan  model  implementation.  This  section  applies  to  aid  categories  speci- 
fied by  the  director,  pursuant  to  Welfare  and  Institutions  Code  Section 
14016.5  and  14087.305. 

(b)  The  following  definitions  apply  to  this  section: 

(1 )  Affiliate  means  an  existing  Medi-Cal  managed  care  plan  that  has 
a  written  agreement  to  become  a  subcontractor  to  the  local  initiative  or 
the  commercial  plan  when  the  local  initiative  or  commercial  plan  com- 
mences operation,  or  an  entity  that  has  been  awarded  the  local  initiative 
or  commercial  plan  contract  under  the  Two-Plan  Model  and  is  an  exist- 
ing Medi-Cal  prepaid  health  plan  contractor  that  is  authorized  under  its 
Medi-Cal  prepaid  health  plan  contract  to  operate  in  the  service  area  to 
which  the  plan  has  been  awarded  the  commercial  plan  or  local  initiative 
contract  under  the  Two-Plan  Model. 

(2)  Assignment  means  the  action  taken  by  the  health  care  options  con- 
tractor to  enroll  an  eligible  beneficiary  or  an  eligible  family  group  into 
aMedi-Cal  managed  care  plan  when  the  beneficiary  fails  to  select  a  man- 
aged care  plan  and  does  not  provide  a  written  certification  of  an  estab- 
lished patient-provider  relationship. 

(3)  Authorized  affihate  means  any  existing  Medi-Cal  prepaid  health 
plan  that  has  been  awarded  the  local  initiative  or  commercial  plan  con- 
tract under  the  Two-Plan  Model,  or  is  an  affiliate  that  has  been  autho- 
rized by  the  department  to  receive  assignments  after  a  local  initiative  or 
commercial  plan  has  submitted  a  written  request  to  the  department  that 
assignments  be  made  to  that  affiliate. 

(4)  Commercial  plan  means  a  prepaid  health  plan  in  a  designated  geo- 
graphic area  awarded  a  contract  by  the  department  pursuant  to  sections 
53800(b)(1). 

(5)  Commercial  plan  enrollment  maximum  means  the  enrollment  lev- 
el established  by  the  department  pursuant  to  section  53820(b). 

(6)  Confirmed  conditional  start  date  means  the  date  established  by  the 
department  on  which  a  local  initiative  or  commercial  plan  is  authorized 
to  begin  operation  under  the  Two  Plan  Model,  subject  to  the  local  initia- 
tive or  commercial  plan  fulfilling  the  conditions  specified  by  the  depart- 
ment at  the  time  the  confirmed  conditional  start  date  is  given  by  the  de- 
partment. 

(7)  CP/LI  ratio  means  the  total  enrollment  of  the  commercial  plan,  or 
if  the  commercial  plan  is  not  operational,  the  combined  total  enrollment 
of  the  commercial  plan  affiliates,  DIVIDED  by  the  combined  total  enrol- 
lment of  the  local  initiative  affihates.  The  source  of  the  enrollment  totals 
is  the  department's  monthly  Medi-Cal  managed  care  capitation  report. 

(8)  Fee-for-service  managed  care  program  means  a  program  operated 
in  a  designated  geographic  area  by  an  entity  contracting  with  the  Depart- 
ment under  which  services  continue  to  be  provided  on  a  fee-for-service 
basis,  but  each  Medi-Cal  beneficiary  is  provided  with  a  primary  care  pro- 
vider who  coordinates  the  beneficiary's  Medi-Cal  health  care. 

(9)  Health  care  options  contractor  means  the  entity  contracting  with 
the  department  to  provide  appUcants  and  beneficiaries  with  information 
on  the  available  options  to  receive  Medi-Cal  benefits  and  to  process 
applicant  and  beneficiary  enrollment  choices  or  assignments  in  desig- 
nated geographic  areas. 

(10)  Health  care  options  presentation  means  a  presentation  in-person 
or  by  mail  to  Medi-Cal  applicants  and  beneficiaries  which  provides  in- 
formation on  the  Medi-Cal  managed  care  plans  and  fee-for-service  op- 


Page  335 


Register  97,  No.  37;  9-12-97 


§  50185.5 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


tions  available  within  the  designated  geographic  area  in  which  the  apph- 
cant  or  beneficiary  resides. 

(iJ)  Local  initiative  means  a  prepaid  health  plan  awarded  a  contract 
by  the  department  pursuant  to  sections  53800(b)(2)  and  53810(h). 

(12)  Local  initiative  enrollment  minimum  means  the  total  number  of 
Medi-Cal  beneficiaries  in  the  mandatory  aid  categories  in  the  designated 
geographic  area  less  the  maximum  enrollment  level  established  pursuant 
to  section  53820  of  the  commercial  plan. 

(13)  Operational  means  a  managed  care  plan  is  providing  covered  ser- 
vices to  enrolled  Medi-Cal  beneficiaries  and  is  entitled  to  receive  capita- 
tion payments  from  the  department. 

(c)  Applicants  and  beneficiaries  shall  be  informed  by  the  county  wel- 
fare department  of  the  availability  of  health  care  options  presentations 
which  explain  the  options  for  receiving  Medi-Cal  benefits  and  the  obli- 
gation of  the  applicants  and  beneficiaries  to  attend  a  presentation.  For 
beneficiaries  who  do  not  attend  a  health  care  options  presentation,  the  de- 
partment shall  mail  information  explaining  the  beneficiary's  health  care 
options. 

( 1 )  The  county  welfare  department  shall  inform  applicants  and  benefi- 
ciaries of  the  availability  of  health  care  options  presentations  at  the  time 
of  their  initial  eligibility  and  annual  redetermination  in  the  following  geo- 
graphic areas: 

(A)  Areas  designated  for  the  two-plan  model,  when: 

1 .  only  the  commercial  plan  is  operational;  or 

2.  only  the  local  initiative  is  operational;  or 

3.  the  department  intends  to  award  two  commercial  plan  contracts  and 
no  local  initiative  contract,  and  only  one  commercial  plan  is  operational. 

(B)  Areas  not  designated  for  the  two-plan  model. 

(2)  If,  within  the  same  geographical  area,  the  local  initiative  is  sched- 
uled to  become  operational  prior  to  the  date  the  commercial  plan  is  ex- 
pected to  become  operational,  the  local  initiative  may  submit  a  written 
request  to  the  department  that  the  department  include  all  existing  benefi- 
ciaries in  the  mandatory  aid  categories  in  the  health  care  options  notifica- 
tion process. 

(d)  At  the  health  care  options  presentation  or  by  mail,  the  department 
shall  provide  to  the  applicant  or  beneficiary  information  on  Medi-Cal 
managed  care  plans  operating  within  the  geographic  area  in  which  the 
applicant  or  beneficiary  resides. 

(e)  Each  applicant  or  beneficiary  shall  submit  in  writing  to  the  health 
care  options  contractor  a  choice  to  enroll  in  a  Medi-Cal  managed  care 
plan  or  shall  certify  in  writing  that  he  or  she  has  an  established  patient- 
provider  relationship  either: 

(1)  within  30  days  of  the  applicant's  or  beneficiary's  attendance  at  a 
health  care  options  presentation;  or, 

(2)  if  the  applicant  or  beneficiary  does  not  attend  a  health  care  options 
presentation  prior  to  the  postmark  date  on  which  the  health  care  options 
materials  were  mailed  to  the  applicant  or  beneficiary,  within  30  days  of 
the  postmark  date  of  the  mailed  health  care  options  materials. 

(t)  The  health  care  options  contractor  shall  assign  beneficiaries  failing 
to  comply  with  the  requirements  of  subsection  (e)  to  an  available  Medi- 
Cal  managed  care  plan  that  has  capacity  to  accept  new  beneficiaries  and 
that  has  a  primary  care  service  site  serving  the  postal  ZIP  code  area  in 
which  the  beneficiary  resides.  To  the  extent  possible,  a  beneficiary  shall 
not  be  assigned  to  a  different  Medi-Cal  managed  care  plan  than  other 
members  of  the  same  family  group. 

(g)  In  geographic  areas  designated  for  health  care  to  be  provided  under 
the  two-plan  model,  if  more  than  one  Medi-Cal  managed  care  plan 
meets  the  conditions  in  (f),  assignments  shall  be  made  as  follows: 

(1)  If  the  local  initiative  is  operational,  all  assignments  will  be  directed 
to  the  local  initiative  until  it  reaches  the  local  initiative  enrollment  mini- 
mum. 

(2)  If  the  local  initiative  is  operational  and  has  attained  its  enrollment 
minimum  and  the  commercial  plan  is  not  operational  but  has  authorized 
affiliates,  one  of  every  two  assignments  will  be  directed  to  the  local  initia- 
tive and  one  will  be  directed  to  an  authorized  affiliate  of  the  commercial 


plan.  Assignments  to  the  commercial  plan's  affiliates  will  be  evenly  dis- 
tributed among  all  authorized  affiliates  of  the  commercial  plan.  Assign- 
ments to  the  authorized  commercial  plan  affiliates  will  continue  until 
their  combined  enrollment  total  reaches  the  commercial  plan  enrollment 
maximum,  at  which  time  assignments  to  authorized  commercial  plan  af- 
filiates will  be  discontinued.  Enrollment  in  the  local  initiative  and  com- 
mercial plan  affiliates  will  be  reviewed  on  a  monthly  basis.  If  the  local 
initiative's  enrollment  falls  below  the  local  initiative's  enrollment  mini- 
mum, all  assignments  will  be  directed  to  the  local  initiative  as  needed  to 
restore  it  to  its  enrollment  minimum.  After  the  local  initiative  has  been 
restored  to  its  enrollment  minimum,  assignments  to  the  authorized  com- 
mercial plan  affiliates  will  be  resumed  as  provided  above  until  the  com- 
mercial plan  affiliates'  combined  enrollment  total  reaches  the  commer- 
cial plan  enrollment  maximum,  at  which  time  assignments  to  authorized 
commercial  plan  affiliates  will  be  discontinued.  If  the  commercial  plan 
does  not  have  any  authorized  affiliates,  all  assignments  will  be  directed 
to  the  local  initiative. 

(3)  If  the  commercial  plan  is  operational  and  the  local,  initiative  is  not 
operafional  but  has  authorized  affiliates,  and  the  combined  total 
enrollment  of  the  local  initiative  affiliates  is  less  than  the  total  enrollment 
of  the  commercial  plan,  assignments  will  be  made  as  follows: 

(A)  If  the  CP/LI  rafio  is  1 .0  or  less,  one  of  every  two  assignments  will 
be  directed  to  an  authorized  affiliate  of  the  local  initiative  and  one  assign- 
ment will  be  directed  to  the  commercial  plan. 

(B)  If  the  CP/LI  ratio  is  greater  than  1 .0  but  less  than  or  equal  to  2.0, 
two  of  every  three  assignments  will  be  directed  to  the  authorized  affili- 
ates of  the  local  initiative  and  one  assignment  will  be  directed  to  the  com- 
mercial plan. 

(C)  It  the  CP/LI  rafio  is  greater  than  2.0  but  less  than  or  equal  to  3.0, 
three  of  every  four  assignments  will  be  directed  to  the  authorized  affili- 
ates of  the  local  initiafi  ve  and  one  assignment  will  be  directed  to  the  com- 
mercial plan. 

(D)  If  the  CP/LI  rafio  is  greater  than  3.0,  four  of  every  five  assignments 
will  be  directed  to  the  authorized  affiliates  of  the  local  initiative  and  one 
assignment  will  be  directed  to  the  commercial  plan. 

(E)  For  (g)(3)(A),  (B),  (C)  and  (D),  assignments  to  the  authorized  local 
initiafive  affiliates  will  be  evenly  distributed  among  all  authorized  affili- 
ates of  the  local  initiative. 

(F)  Once  (g)(3)(B),  (C),  or  (D)  have  been  applied,  and  the  CP/LI  rafio 
reaches  1.0  or  less,  until  90  days  prior  to  the  Local  Inifiative's  confirmed 
conditional  start  date,  one  of  every  two  assignments  will  be  directed  to 
an  authorized  affiliate  of  the  local  initiative  and  one  assignment  will  be 
directed  to  the  commercial  plan.  No  further  use  of  the  CP/LI  rafio  will 
be  made  to  determine  assignments.  When  the  commercial  plan  reaches 
its  enrollment  maximum,  further  assignments  to  the  commercial  plan 
will  be  discontinued.  Enrollment  totals  in  the  commercial  plan  and  the 
combined  enrollment  total  for  the  local  initiafive  affiliates  will  be  re- 
viewed on  a  monthly  basis.  If  enrollment  falls  below  the  commercial 
plan  enrollment  maximum,  assignments  to  the  commercial  plan  will  be 
resumed  with  the  commercial  plan  receiving  one  of  every  two  assign- 
ments until  the  commercial  plan  reaches  the  commercial  plan  enrollment 
maximum. 

(G)  Beginning  90  days  prior  to  a  local  inifiative's  confirmed  condition- 
al start  date,  all  assignments  will  be  made  to  the  authorized  affiliates  of 
the  local  initiative.  These  assignments  will  be  evenly  distributed  among 
aU  authorized  affiliates  of  the  local  initiative.  When  enrollment  in  the  af- 
filiates of  the  local  initiative  reaches  the  local  initiative's  minimum  enrol- 
lment, one  of  every  two  assignments  will  be  directed  to  an  authorized  af- 
filiate of  the  local  inifiative  and  one  assignment  will  be  directed  to  the 
commercial  plan.  Assignments  to  the  authorized  affiliates  of  the  local 
inifiafive  will  be  evenly  distributed  among  all  authorized  affiliates  of  the 
local  initiative.  Assignments  to  the  commercial  plan  will  continue  until 
the  enrollment  total  of  the  commercial  plan  equals  the  commercial  plan 
enrollment  maximum,  at  which  time  assignments  to  the  commercial  plan 
will  be  discontinued.  The  enrollment  total  of  the  commercial  plan  and 


Page  336 


Register  97,  No.  37;  9-12-97 


Title  22 


Health  Care  Services 


§  50185.5 


• 


the  combined  enrollment  total  for  the  affiliates  of  the  local  initiative  will 
be  reviewed  on  a  monthly  basis.  If  the  combined  enrollment  of  the  affili- 
ates of  the  local  initiative  falls  below  the  local  initiative's  enrollment 
minimum,  all  assignments  will  be  directed  to  the  authorized  affiliates  of 
the  local  initiative  as  needed  to  restore  the  combined  enrollment  in  affili- 
ates of  the  local  initiative  to  the  local  initiative  enrollment  minimum.  Af- 
ter enrollment  in  the  alTihates  of  the  local  initiative  has  been  restored  to 
its  enrollment  minimum,  assignments  to  the  commercial  plan  will  be  re- 
sumed as  provided  above  until  the  commercial  plan's  enrollment  reaches 
the  commercial  plan  enrollment  maximum,  at  which  time  assignments  to 
the  commercial  plan  will  be  discontinued. 

(4)  If  the  commercial  plan  is  operational,  and  the  local  initiative  is  not 
operational  but  has  authorized  affiliates,  and  the  combined  enrollment  of 
the  local  initiative  affiliates  is  equal  to  or  greater  than  the  enrollment  in 
the  commercial  plan,  one  of  every  two  assignments  will  be  directed  to  an 
authorized  affiliate  of  the  local  initiative  and  one  assignment  will  be  di- 
rected to  the  commercial  plan.  When  the  commercial  plan  reaches  its  en- 
rollment maximum,  further  assignments  to  the  commercial  plan  will  be 
discontinued.  Enrollment  totals  in  the  commercial  plan  and  the  com- 
bined enrollment  total  for  the  local  initiative  affiliates  will  be  reviewed 
on  a  monthly  basis.  If  enrollment  falls  below  the  commercial  plan 
enrollment  maximum,  assignments  to  the  commercial  plan  will  be  re- 
sumed with  the  commercial  plan  receiving  one  of  every  two  assignments 
until  the  commercial  plan  reaches  the  commercial  plan  enrollment  maxi- 
mum. 

(5)  If  the  commercial  plan  is  operational,  and  the  local  initiative  is  not 
operational  and  the  local  initiative  does  not  have  any  authorized  affili- 
ates, all  assignments  will  be  directed  to  the  commercial  plan.  When  the 
commercial  plan  reaches  its  enrollment  maximum,  further  assignment  to 
the  commercial  plan  will  be  discontinued.  Enrollment  in  the  commercial 
plan  will  be  reviewed  on  a  monthly  basis.  If  enrollment  falls  below  the 
commercial  plan  enrollment  maximum,  assignments  to  the  commercial 
plan  will  be  resumed  with  the  commercial  plan  receiving  all  assignments 
until  the  commercial  plan  reaches  its  enrollment  maximum. 

(6)  If  neither  the  local  initiative  nor  commercial  plan  is  operational,  but 
either  one  or  both  has  authorized  affiliates,  assignment  shall  be  as  fol- 
lows: 

(A)  If  the  local  initiative  does  not  have  any  authorized  affiliates  and 
the  commercial  plan  has  authorized  affiliates,  all  assignments  will  be  di- 
rected to  the  commercial  plan's  authorized  affiliates.  When  the  com- 
bined total  enrollment  of  the  commercial  plan's  affiliates  reaches  the 
commercial  plan  maximum,  further  assignments  to  the  commercial 
plan's  authorized  affiliates  will  be  discontinued.  Enrollment  in  the  com- 
mercial plan's  affiliates  will  be  reviewed  on  a  monthly  basis.  If  the  com- 
bined total  enrollment  of  the  commercial  plan's  affiliates  falls  below  the 
commercial  plan  maximum,  assignments  will  be  resumed  until  the  com- 
bined enrollment  in  the  commercial  plan's  affiliates  reaches  the  commer- 
cial plan  maximum. 

(B)  If  the  local  initiative  has  authorized  affiliates  and  the  commercial 
plan  does  not  have  authorized  affiliates,  all  assignments  will  be  directed 
to  the  authorized  affiliates  of  the  local  initiative. 

(C)  If  the  local  initiative  has  not  been  given  a  confirmed  conditional 
start  date  by  the  department,  and  the  combined  total  enrollment  of  the  lo- 
cal initiative  affiliates  is  less  than  the  combined  total  enrollment  of  the 
commercial  plan  affiliates,  until  the  combined  total  enrollment  of  the  lo- 
cal inifiative  affiliates  is  equal  to  or  greater  than  the  combined  total 
enrollment  of  the  commercial  plan  affiliates,  assignments  will  be  made 
as  follows: 

1.  If  the  CP/LI  ratio  is  1.0  or  less,  one  of  every  two  assignments  will 
be  directed  to  the  authorized  affiliates  of  the  local  initiative  and  one  as- 
signment will  be  directed  to  an  authorized  affiUate  of  the  commercial 
plan. 

2.  If  the  CP/LI  ratio  is  greater  than  1 .0  but  less  than  or  equal  to  2.0,  two 
of  every  three  assignments  will  be  directed  to  the  authorized  affiliates  of 


the  local  inifiafive  and  one  assignment  will  be  directed  to  an  authorized 
affiliate  of  the  commercial  plan. 

3.  If  the  CP/LI  ratio  is  greater  than  2.0  but  less  than  or  equal  to  3.0,  three 
of  every  four  assignments  will  be  directed  to  the  authorized  affiliates  of 
the  local  inifiative  and  one  assignment  will  be  directed  to  an  authorized 
affiliate  of  the  commercial  plan. 

4.  If  the  CP/LI  ratio  is  greater  than  3.0,  four  of  every  five  assignments 
will  be  directed  to  the  authorized  affiliates  of  the  local  initiative  and  one 
assignment  will  be  directed  to  an  authorized  affiliate  of  the  commercial 
plan. 

5.  For  (g)(6)(C)(l),  (2),  (3)  and  (4),  assignments  to  the  authorized  affil- 
iates of  the  local  initiaUve  will  be  evenly  distributed  among  all  authorized 
affihates  of  the  local  initiative  and  assignments  to  authorized  affiliates  of 
the  commercial  plan  will  be  evenly  distributed  among  all  authorized  af- 
filiates of  the  commercial  plan. 

6.  Once  (g)(6)(C),  (2),  (3)  or  (4)  have  been  applied,  and  the  CP/LI  ratio 
reaches  l.O  or  less,  until  90  days  prior  to  the  local  inifiative's  confirmed 
conditional  start  date,  one  of  every  two  assignments  will  be  directed  to 
an  authorized  affiliate  of  the  local  initiative  and  one  assignment  will  be 
directed  to  an  authorized  affihate  of  the  commercial  plan.  No  further  use 
of  the  CP/LI  rafio  will  be  made  to  determine  assignments.  Assignments 
to  the  authorized  affiliates  of  the  local  initiative  will  be  evenly  distributed 
among  all  authorized  affiliates  of  the  local  inifiative  and  assignments  to 
the  authorized  affihates  of  the  commercial  plan  will  be  evenly  distributed 
among  all  authorized  affiliates  of  the  commercial  plan.  Assignments  to 
the  authorized  affiliates  of  the  commercial  plan  will  continue  until  the 
combined  enrollment  total  of  the  affiliates  of  the  commercial  plan  equals 
the  commercial  plan  enrollment  maximum,  at  which  fime  assignments  to 
authorized  affiliates  of  the  commercial  plan  will  be  discontinued.  In  the 
case  of  an  affiliate  that  has  affiliated  with  both  the  local  initiative  and  the 
commercial  plan,  the  total  enrollment  of  that  affiliate  will  be  included  in 
the  combined  commercial  plan  enrollment  totals  to  determine  if  the  com- 
mercial plan  enrollment  maximum  has  been  reached.  The  combined  en- 
rollment total  for  the  affiliates  of  the  commercial  plan  and  combined  total 
for  the  affiliates  of  the  local  initiative  will  be  reviewed  on  a  monthly  ba- 
sis. If  the  local  inifiative's  enrollment  falls  below  the  local  initiative's 
enrollment  minimum,  all  assignments  will  be  directed  to  the  local  initia- 
Uve as  needed  to  restore  it  to  its  enrollment  minimum.  After  the  local  ini- 
fiative has  been  restored  to  its  enrollment  minimum,  assignments  to  the 
authorized  affiliates  of  the  commercial  plan  will  be  resumed  as  provided 
above  unfil  the  combined  enrollment  of  the  authorized  affiliates  of  the 
commercial  plan  reaches  the  commercial  plan  enrollment  maximum,  at 
which  fime  assignments  to  the  authorized  affiliates  of  the  commercial 
plan  will  be  disconfinued. 

(D)  If  the  combined  enrollment  of  the  affiliates  of  the  local  initiafive 
is  equal  to  or  greater  than  the  combined  enrollment  of  the  affihates  of  the 
commercial  plan,  one  of  every  two  assignments  will  be  directed  to  an  au- 
thorized affiliate  of  the  local  inifiafive  and  one  assignment  will  be  di- 
rected to  an  authorized  affiliate  of  the  commercial  plan.  Assignments  to 
the  authorized  affiliates  of  the  local  initiative  will  be  evenly  distributed 
among  all  authorized  affiliates  of  the  local  inifiafive,  and  assignments  to 
the  authorized  affiliates  of  the  commercial  plan  will  be  evenly  distributed 
among  all  authorized  affiliates  of  the  commercial  plan.  Assignments  to 
the  authorized  affiliates  of  the  commercial  plan  will  continue  until  the 
combined  enrollment  total  of  affiliates  of  the  commercial  plan  equals  the 
commercial  plan  enrollment  maximum,  at  which  time  assignments  to  the 
authorized  affiliates  of  the  commercial  plan  will  be  discontinued.  In  the 
case  of  an  affiliate  that  has  affiliated  with  both  the  local  initiative  and  the 
commercial  plan,  the  total  enrollment  of  that  affiliate  will  be  included  in 
the  combined  commercial  plan  enrollment  totals  to  determine  if  the  com- 
mercial plan  enrollment  maximum  has  been  reached.  The  combined  en- 
rollment total  for  the  affiliates  of  the  commercial  plan  and  combined  total 
for  the  affiliates  of  the  local  inifiafive  will  be  reviewed  on  a  monthly  basis. 
If  enrollment  falls  below  the  commercial  plan  enrollment  maximum,  as- 


Page  336.1 


Register  97,  No.  37;  9-12-97 


§  50185.5 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


signments  to  the  authorized  affiliates  of  the  commercial  plan  will  be  re- 
sumed with  the  commercial  plan  receiving  one  ofevery  two  assignments 
until  the  combined  enrollment  of  the  affiliates  of  the  commercial  plan 
reaches  the  commercial  plan  enrollment  maximum. 

(E)  Beginning  90  days  prior  to  a  local  initiative's  confirmed  condition- 
al start  date,  all  assignments  will  be  made  to  the  authorized  affiliates  of 
the  local  initiative.  These  assignments  will  be  evenly  distributed  among 
all  authorized  affiliates  of  the  local  initiative.  When  enrollment  in  the  af- 
fihates  of  the  local  initiative  reaches  the  local  initiative's  minimum 
enrollment,  one  of  every  two  assignments  will  be  directed  to  an  autho- 
rized affiliate  of  the  local  initiative  and  one  assignment  will  be  directed 
to  an  authorized  affiliate  of  the  commercial  plan.  Assignments  to  the  au- 
thorized affiliates  of  the  local  initiative  will  be  evenly  distributed  among 
all  authorized  affiliates  of  the  local  initiative  and  assignments  to  the  au- 
thorized affiliates  of  the  commercial  plan  will  be  evenly  distributed 
among  all  authorized  affiliates  of  the  commercial  plan.  Assignments  to 
the  authorized  affiliates  of  the  commercial  plan  will  continue  until  the 
combined  enrollment  total  of  the  affiliates  of  the  commercial  plan  equals 
the  commercial  plan  enrollment  maximum,  at  which  time  assignments  to 
authorized  affiliates  of  the  commercial  plan  will  be  discontinued.  In  the 
case  of  an  affiliate  that  has  affiliated  with  both  the  local  initiative  and  the 
commercial  plan,  the  total  enrollment  of  that  affihate  will  be  included  in 
the  commercial  plan's  enrollment  totals  to  determine  if  the  commercial 
plan  enrollment  maximum  has  been  reached.  The  combined  enrollment 
total  of  the  affiliates  of  the  commercial  plan  and  combined  enrollment  to- 
tal for  the  affiliates  of  the  local  initiative  will  be  reviewed  on  a  monthly 
basis.  If  enrollment  falls  below  the  commercial  plan  enrollment  maxi- 
mum, assignments  to  the  authorized  affiliates  of  the  commercial  plan  will 
be  resumed  with  one  ofevery  two  assignments  directed  to  the  authorized 
affiliates  of  the  commercial  plan  until  the  combined  enrollment  of  the  af- 
filiates of  the  commercial  plan  reaches  its  enrollment  maximum.  If  the 
commercial  plan  does  not  have  any  authorized  affiliates,  all  assignments 
will  be  directed  to  the  authorized  affiliates  of  the  local  initiative. 

(7)  Where  the  department  awards  two  commercial  plan  contracts  and 
no  local  initiative  contract,  assignment  shall  be  as  follows: 

(A)  If  neither  commercial  plan  is  operational,  assignments  will  be 
evenly  distributed  among  authorized  affiliates  of  the  two  commercial 


plans.  When  the  combined  total  enrollment  of  a  commercial  plan's  affili- 
ates totals  one-half  of  the  mandatory  enrollment  population,  assign- 
ments will  cease  for  the  authorized  affiliates  of  that  plan.  In  the  case  of 
an  affiliate  that  has  affiliated  with  both  commercial  plans,  the  total  enrol- 
lment of  this  affiliate  will  be  equally  divided  for  purposes  of  computation 
of  the  enrollment  total  to  determine  when  assignments  will  cease. 

(B)  If  a  single  commercial  plan  is  operational,  assignments  will  be 
evenly  distributed  among  the  operational  commercial  plan  and  the  autho- 
rized affiliates  of  the  nonoperational  commercial  plan.  Assignments  to 
the  authorized  affiliates  of  the  nonoperational  commercial  plan  will  be 
evenly  distributed.  When  the  total  enrollment  of  the  single  operational 
commercial  plan  or  the  combined  total  enrollment  of  the  authorized  affil- 
iates of  the  nonoperational  commercial  plan  equals  one-half  of  the  man- 
datory enrollment  in  the  designated  geographic  area,  assignments  will 
cease  for  that  plan.  In  the  case  of  an  affiliate  that  has  affiliated  with  both 
the  operational  and  nonoperational  commercial  plan,  the  total  enrollment 
of  that  affihate  will  be  equally  divided  for  purposes  of  computation  of  the 
enrollment  total  to  determine  when  assignments  will  cease. 

(8)  If  both  the  local  initiative  and  the  commercial  plan  become  opera- 
tional in  a  geographic  area  prior  to  the  implementation  of  mandatory  en- 
rollment of  beneficiaries  in  the  two  plan  model,  assignments  will  be  di- 
rected to  the  local  initiative  until  it  reaches  its  enrollment  minimum,  then 
assignments  will  be  evenly  distributed  between  the  local  initiative  and 
the  commercial  plan.  No  assignments  will  be  made  to  other  Medi-Cal 
managed  care  plans.  When  the  commercial  plan  reaches  its  enrollment 
maximum,  further  assignment  to  the  commercial  plan  will  be  discontin- 
ued. Enrollment  in  the  local  initiative  and  commercial  plan  will  be  re- 
viewed on  a  monthly  basis.  If  the  local  initiative's  enrollment  falls  below 
the  local  initiative's  enrollment  minimum,  all  assignments  wih  be  di- 
rected to  the  local  initiative  as  needed  to  restore  it  to  its  enrollment  mini- 
mum. After  the  local  initiative  has  been  restored  to  its  enrollment  mini- 
mum, assignments  to  the  commercial  plan  will  be  resumed  as  provided 
above  until  the  commercial  plan's  enrollment  reaches  the  commercial 
plan  enrollment  maximum,  at  which  time  assignments  to  the  commercial 
plan  will  be  discontinued. 

(9)  This  is  a  graphic  presentation  that  illustrates  the  requirements  set 
forth  in  secuons  (g)(1),  (g)(2),  (g)(3),  (g)(4),  (g)(5),  (g)(6)  and  (g)(8): 


Page  336.2 


Register  97,  No.  37;  9-12-97 


ore 


LI  is  not 

LI  is  not  Operadona)  but  bas  Autfiorized  Affiliates  A  LI  does 

LI  widi  Authorized 

LI  is  Operational: 

LI  is  Operational: 

Opcrationa]  and 

NOT  have  a  Confirmed  ConditionaJ  Start  Date 

AflUiates,  8t 

LI  Enrollment  <  LI 

LI  Enrollment  >_  LI 

has  NO 

Beginning  90  days 

Minimum 

Minimum 

Authorized 

prior  to  Confunud 

Affiliates 

Cond'l  Start  Date 

CP  is  not 

No  assignments. 

(gK6KB). 

(g)(6)(B)  & 

(gXl). 

(gK2). 

Operational  and  has 

All  assignments  to  the  authorized  affiliates  of  the  LI. 

(gX6KE). 

All  assignments  to 

All  assignments  to 

NO  Authorized 

All  assignments  to 

the  LI, 

the  LI. 

AfTiliates 

tfic  autfa.  affiliates  of 
theLL 

CP  is  not 

(gK6KA). 

(g)(6)(C). 

(gK6KE).   AU 

(g)(1)-   All 

(gK2).    lof2 

Operational  hut  has 

All  assignments  to 

I .    IfCP/U  ratio  ♦  <^  /.  1  of  2  assignments  to  the 

assignments  to  auth. 

assignments  to  the  LI 

assignments  to  the 

Authorized  Affiliates 

authorized 

authorized  affiliates  of  the  LI. 

affiliates  of  the  LI 

until  it  reaches  die 

LI. 

affiliates  of  CP. 

2.    If  CP/U  ratio  >1  and  <_  2.  2  of  3  assignmente  to  the 

until  it  reaches  the 

LI  Min.   After  the 

authorized  affiliates  of  the  LI. 

LI  Min.  After  LI 

LI  Min  is  reached 

3.    If  the  CP/U  ratio  >2  but  <_  S,  3  of  4  assignments  to  the 

Min.  is  reached  then 

then  1  of  2 

authorized  affiliates  of  the  LI. 

1  of  2  assignments  to 

assignments  to  LI. 

4.    If  the  CP/U  ratio  >  J,  4  of  5  assignments  to  the 

authorized  affiliates  of  the  LI. 
6.  If  the  combined  enrollment  of  LI  affiliates   =  combined 
CP  affiliate  enrollment,  then  1  of  2  assignments  to  the 
authorized  affiliates  of  the  LI. 

the  authorized 
affdiates  of  the  LI. 

CP  is  Operational: 

{g)(5). 

(g)(3). 

(g)(3KG).   All 

(g)(1).    All 

(g)(8).    lof2 

Enrollment  is  <  CP 

All  assignments  to 

(A)  If  CP/U  ratio  •  ^  7,  I  of  2  assignments  to  the 

assignments  to  the 

assignments  to  the  LI 

assignments  to  the 

Mu. 

CP. 

audiorized  affiliates  of  the  LI. 

auth.  affiliates  of  die 

undl  it  reaches  the 

LI. 

(B)  If  CP/U  ratio  >I  and  <_2,  2  of  3  assignments  to  the 

LI  until  it  reaches 

LI  Min.    After  the 

authorized  affiliates  of  the  LI.. 

the  LI  Min.  After  LI 

LI  Min  is  reached 

(C)  If  the  CP/U  ratio  >2  />itf  <_  i,  3  of  4  assignments  to  the 

Min.  is  reached  then 

then  1  of  2 

authorized  affiliates  of  the  LI.. 

1  of  2  assignments  to 

assignments  to  LI. 

(D)  If  the  CP/U  ratio  >i,  4  of  5  assignments  to  the 

the  authorized 

authorized  affiliates  of  the  LI. 

affiliates  of  the  LI. 

(F)  If  die  combined  enrolhoent  of  the  LI  affdiates  =  CP 

enrollment,  then  1  of  2  assignments  to  the  authorized 

affiliates  of  the  LI. 

CP  Operational: 

(g)(5): 

(gK3KF)  &  (g)(4).     All  assignments  to  the  authorized  afTiliates  of 

(g)(3KG).   All 

(g)(8).   All 

(gK8).    All 

EmoUment  is  ^  CP 

No  assignments. 

the  LI. 

assignments  to  auth. 

assignments  to  LI. 

assignmenu  to  LI. 

JMax. 

affiliates  of  the  LI. 

•  CP/LI  ratio  means  the 

total  enrollment  of  ttie 

commercial  plan,  or  if  the  commercial  plan  is  not  operational  the  combined  total  enrollment  ot  the  commercial  plan  aftuiatcs.  DIViUbL)  by  the 

combined  total  enrollment  of  the  local  initiative  affiliates. 


§  50186 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


(h)  In  geographic  areas  not  designated  for  two-plan  model  implemen- 
tation, if  the  department  contracts  for  a  fee-for-service  managed  care 
program,  assignments  will  be  directed  to  the  fee-for-service  managed 
care  contractor  as  long  as  the  contractor  has  an  available  capacity.  In  oth- 
er geographic  areas,  assignments  will  be  evenly  distributed  among 
Medi-Cal  managed  care  plans  which  have  been  approved  by  the  depart- 
ment to  participate  in  the  assignment  process  and  have  available  enrol- 
lment capacity  consistent  with  the  growth  limits  pursuant  to  section 
53830. 

(i)  The  health  care  options  contractor  shall  notify  the  beneficiary  in 
writing  of  the  beneficiary '  s  assignment  to  a  Medi-Cal  managed  care  plan 
at  least  ten  working  days  prior  to  the  submission  of  the  assignment  docu- 
ments to  the  department  for  processing.  The  notice  shall  contain  the  name 
of  the  Medi-Cal  managed  care  plan  to  which  the  beneficiary  is  assigned; 
the  conditions  defined  in  subdivisions  (j)(l),  (2)  and  (3);  and  the  time 
frame  for  advising  the  health  care  options  contractor  if  the  assignment  is 
not  appropriate  or  if  the  beneficiary  wishes  to  enroll  in  a  different  Medi- 
Cal  managed  care  plan  or  certify  to  a  patient-provider  relationship. 

(i)  An  assignment  is  not  appropriate  when: 

(1)  The  time  and  distance  a  beneficiary  is  required  to  travel  to  obtain 
primary  care  services  from  his  or  her  residence  exceeds  the  normal  prac- 
tice for  the  commum'ty  or  30  minutes  or  10  miles,  whichever  is  greater. 

(2)  Public  transportation  is  not  available  to  the  primary  care  site,  unless 
the  managed  care  plan  to  which  the  beneficiary  is  assigned  provides 
transportation  for  outpatient  services.  This  criteria  will  not  apply  to  the 
designated  fee-for-service  managed  care  program  geographic  areas 
where  public  transportation  to  Medi-Cal  services  has  not  historically 
been  available  to  the  beneficiary. 

(3)  Culturally  and  linguistically  appropriate  services  are  not  available 
to  the  beneficiary. 

(k)  The  beneficiary  may  notify  the  health  care  options  contractor  that 
the  assignment  meets  one  or  more  of  the  conditions  in  subdivisions  (j)(l), 
(2),  or  (3)  or  the  beneficiary  requests  enrollment  in  another  Medi-Cal 
managed  care  plan.  The  beneficiary  may  also  certify  to  a  patient-provid- 
er relationship.  The  notice  from  the  beneficiary  shall  be  in  writing  and 
state,  if  apphcable,  the  specific  condition(s)  making  the  assignment  inap- 
propriate and  the  desired  action  by  the  health  care  options  contractor. 

(1)  For  such  notices  from  beneficiaries  received  within  ten  working 
days  of  the  postmark  date  of  the  notice  of  assignment  from  the  health  care 
options  contractor,  the  health  care  options  contractor  shall  respond  by  ac- 
cepting the  patient-provider  certification,  if  provided,  or  by  enrolling  the 
beneficiary  in  another  Medi-Cal  managed  care  plan  of  his  or  her  choice. 

(2)  For  such  notices  from  beneficiaries  received  after  the  tenth  work- 
ing day  from  the  postmark  date  of  the  notice  of  assignment  from  the 
health  care  options  contractor,  the  health  care  options  contractor  shall  as- 
sist the  beneficiary  to  disenroU  from  the  assigned  Medi-Cal  managed 
care  plan  and  then  either  accept  the  patient-provider  certification  or  en- 
roll the  beneficiary  in  another  Medi-Cal  managed  care  plan  of  his  or  her 
choice. 

(3)  If  the  beneficiary  notifies  the  health  care  options  contractor  that  the 
assignment  is  inappropriate  because  one  or  more  of  the  conditions  de- 
scribed in  subdivisions  (j)(l),  (2),  and  (3)  exist,  and  if  another  Medi-Cal 
managed  care  plan  within  the  geographic  area  cannot  provide  for  an  ap- 
propriate assignment  in  relation  to  the  conditions  in  (j){\),  (2)  and  (3),  or 
if  another  Medi-Cal  managed  care  plan  within  the  geographic  area  can 
provide  for  appropriate  assignment  in  relation  to  the  conditions  in  (j)(l), 
(2)  and  (3),  but  does  not  have  available  capacity,  the  beneficiary  may 
elect  to  obtain  benefits  by  receiving  a  fee-for-service  card  whether  or  not 
the  beneficiary  has  certified  to  a  patient-provider  relationship. 

Note-  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14016.5,  14016.6  and  14087.305,  Welfare  and  Institu- 
tions Code. 

History 

1.  New  section  filed  7-10-95;  operative  7-10-95.  Submitted  to  OAL  for  printing 
only  pursuant  to  section  147,  SB  485  (Ch.  722/92)  (Register  95,  No.  28). 


2.  Amendmenl  of  section  filed  6-26-96;  operative  6-26-96.  Submitted  to  OAL 
for  printing  only  pursuant  to  Section  1 47  SB  485  (Ch.  722/92)  (Reaister  96,  No. 
27). 

3.  Amendment  filed  8-30-96;  operative  8-30-96.  Submitted  to  OAL  for  printing 
only  (Register  96,  No.  36). 

§  50186.    Unconditionally  Available  Income. 

(a)  An  applicant  or  beneficiary  shall,  as  a  condition  of  Medi-Cal  eligi- 
bility, take  all  actions  necessary  to  obtain  unconditionally  available  in- 
come. This  includes  applying  for  such  income  and  cooperating  in  supply- 
ing the  information  requested  by  the  agency  making  the  award 
determination. 

(b)  Income  shall  be  considered  unconditionally  available  if  the  appli- 
cant or  beneficiary  has  only  to  claim  or  accept  the  income.  Such  income 
includes,  but  is  not  limited  to: 

(1)  Disability  insurance  benefits. 

(2)  Benefits  available  to  veterans  of  military  service. 

(3)  OASDI  benefits. 

(4)  Unemployment  insurance  benefits. 

(c)  Public  assistance  benefits  shall  not  be  considered  unconditionally 
available  income. 

(d)  Only  the  person  who  refuses  to  apply  for  and  accept  unconditional- 
ly available  income  shall  be  rendered  ineligible  by  such  refusal. 

NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4  and  14005.7,  Welfare  and  Institutions  Code. 

History 

1.  New  section  filed  8-8-80;  effective  thirtieth  day  thereafter  (Register  80,  No. 
32). 

§  50187.    Social  Security  Numbers  and  Health  Insurance 
Claim  Numbers. 

(a)  Each  applicant  or  beneficiary  shall,  as  a  condition  of  eligibility  for 
full  Medi-Cal  benefits,  obtain  and  provide  to  the  county  department  a 
Social  Security  Number  (SSN)  and,  if  eligible,  a  Social  Security  Health 
Insurance  Claim  (HIC)  Number.  In  addition,  amnesty  aliens  eligible  for 
restricted  Medi-Cal  benefits  pursuant  to  section  50302(b)(3)  must  pos- 
sess or  have  applied  for  an  SSN  and,  if  eligible,  a  HIC  number. 

(b)  The  SSN  shall  be  provided  at  the  time  of  application  unless  the 
applicant  must  apply  for  the  number.  If  application  for  an  SSN  must  be 
made,  the  number  will  be  provided  to  the  county  department  by  the  De- 
partment or  by  the  Social  Security  Administration. 

(c)  The  HIC  number  shall  be  provided  by  the  applicant  or  beneficiary 
in  accordance  with  section  50777. 

(d)  Medi-Cal  shall  not  be  denied,  delayed  or  discontinued  for  an  appli- 
cant or  beneficiary  because  of  these  requirements  unless  the  applicant  or 
beneficiary  refuses  to  cooperate. 

(1)  Ehgibility  of  an  applicant  or  beneficiary  who  refuses  to  apply  for 
or  provide  a  number  shall  be  denied  or  discontinued. 

(2)  Eligibility  of  a  child  who  is  not  applying  on  the  child's  own  behalf 
shall  be  denied  or  discontinued  if  a  parent  or  caretaker  relative  living  with 
the  child  refuses  to  apply  for  or  provide  a  number  for  the  child. 

(3)  Persons  ineligible  for  Medi-Cal  in  accordance  with  (1 )  or  (2)  shall 
be  ineligible  members  of  the  MFBU  in  accordance  with  section  50379. 

(e)  The  county  department  shall  assist  the  applicant  or  beneficiary  by 
explaining  how  to  apply  for  an  SSN  orHIC  number  and  by  providing  an 
SSA  Referral  Notice,  form  MC  194. 

(f)  The  county  shall  notify  the  beneficiary  if  the  information  provided 
by  that  beneficiary  does  not  result  in  verification  of  the  SSN  by  SSA. 
Medi-Cal  eligibility  shall  be  discontinued  if  the  beneficiary  fails,  with- 
out good  cause,  to  respond  to  the  notice  within  60  days. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institufions 
Code.  Reference:  Sections  14005.7  and  1401 1,  Welfare  and  Institutions  Code;  and 
Section  1320b(7)(a),  Title  42,  United  States  Code  of  Regulations. 

History 

1 .  Amendment  of  subsection  (d)(3)  filed  12-15-77;  effective  thirtieth  day  thereaf- 
ter (Register  77,  No.  51). 

2.  Amendment  filed  4-9-80;  effective  thirtieth  day  thereafter  (Register  80,  No. 
15). 


Page  336.4 


Register  96,  No.  36;  9-6-96 


Title  22 


Health  Care  Services 


§  50193 


3.  Amendment  of  subsection  (d)  (3)  filed  1-8-8 1 ;  effective  thirtieth  day  thereafter 
(Register  81,  No.  2). 

4.  Amendment  of  subsection  (a)  filed  1 1-14-89  as  an  emergency  pursuant  to  sec- 
tion 9  of  chapter  1441  of  the  Statutes  of  1988;  operative  ll-14-89  (Register  89, 
No.  48).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  3-14-90. 

5.  Amendment  of  subsection  (a)  refiled  3-8-90  as  an  emergency  pursuant  to  sec- 
tion 9  of  chapter  1441  of  the  Statutes  of  1 988;  operative  3-13-90  (Register  90, 
No.  12).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  7-11-90. 

6.  Certificate  of  Compliance  as  to  3-8-90  order  transmitted  to  OAL  7-5-90  and 
disapproved  8-6-90  (Register  90,  No.  42). 

7.  Amendment  of  subsection  (a)  filed  8-23-90  as  an  emergency  pursuant  to  sec- 
tion 9  of  chapter  1441  of  the  Statutes  of  1988;  operative  8-23-90  (Register  90, 
No.  42).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  12-21-90 
or  emergency  language  will  be  repealed  by  operation  of  law  on  the  following 
day. 

8.  Certificate  of  Compliance  as  to  8-23-90  order  transmitted  to  OAL  1 1-20-90 
and  filed  12-17-90  (Register  91,  No.  5). 

§  50189.    Redetermination — Frequency  and  Process. 

(a)  Persons  or  families  determined  to  be  eligible  for  Medi-Cal  shall 
have  their  eligibility  redetermined  at  least  once  every  1 2  months. 

(b)  At  the  time  of  the  redetermination,  the  beneficiary  shall  complete 
a  new  Statement  of  Facts. 

(c)  The  county  department  shall: 

(1)  Complete  the  redetermination  within  12  months  of  the  most  recent 
of  the  following: 

(A)  Approval  of  eligibility  on  any  application,  reapplication  or  resto- 
ration which  required  a  Statement  of  Facts  form. 

(B)  Last  redetermination. 

(2)  Inform  beneficiaries  in  writing  that  income  and  eligibility  informa- 
tion, including  tax  information,  will  be  obtained  through  the  lEVS. 

(3)  Verify  information  on  the  Statement  of  Facts  in  accordance  with 
Section  50169  (d). 

(4)  Send  a  Notice  of  Action  if  there  is  a  change  in  the  beneficiary' s  eli- 
gibility status  or  share  of  cost. 

(5)  Provide  an  informational  pamphlet  on  the  CHDP  program  to  the 
beneficiary  which  describes  the  CHDP  benefits  available,  and  how  and 
where  the  benefits  are  provided  in  the  county,  if  there  are  persons  under 
21  years  of  age  in  the  family. 

(d)  A  face-to-face  interview  shall  be  required  at  the  time  of  redetermi- 
nation for  all  MFBUs  which  contain  at  least  one  AFDC-MN  or  MI  mem- 
ber, except  for  MFBUs  consisting  of  any  of  the  following: 

(1)  Persons  who  receive  Medi-Cal  through  the  Aid  for  Adoption  of 
Children  program. 

(2)  Persons  who  have  a  government  representative,  such  as  a  public 
guardian,  acting  on  their  behalf 

(3)  MI  children  who  are  not  living  with  a  parent  or  relative  and  for 
whom  a  public  agency  is  assuming  financial  responsibility  in  whole  or 
in  part. 

NOTE:  Authority  cited:  Sections  10725,  10740  and  14124.5,  Welfare  and  Institu- 
tions Code.  Reference:  Sections  11004,  14001,  14005.4  and  14012,  Welfare  and 
Institutions  Code;  and  42  Code  of  Federal  Regulations  435.945(d). 

History 

1.  Amendment  of  subsecfions  (c)  and  (d)  filed  12-15-77;  effective  thirtieth  day 
thereafter  (Register  77,  No.  51). 

2.  Amendment  of  subsection  (c)(1)(A)  filed  8-7-78;  effective  thirtieth  day  there- 
after (Register  78,  No.  32). 

3.  Amendment  of  subsection  (d)  filed  9-1-78;  effecUve  thirtieth  day  thereafter 
(Register  78,  No.  35). 

4.  Editorial  cortection  to  History  Note  3  (Register  78,  No.  40). 

5.  Amendment  of  subsection  (d)(3)  filed  8-8-80;  effective  thirtieth  day  thereafter 
(Register  80,  No.  32). 

6.  Editorial  correcfion  of  subsection  (c)(1)(A)  filed  7-7-83  (Register  83,  No.  29). 

7.  Amendment  of  subsecfion  (c)  filed  7-16-87;  operative  7-16-87  pursuant  to 
Government  Code  Section  11346.2(d)  (Register  87,  No.  30). 

§  501 91 .    Status  Reports. 

(a)  The  county  department  shall  require  the  completion  of  a  Medi-Cal 
Status  Report  form  at  three  month  intervals  for  all  MFBU's  which  con- 
tain at  least  one  AFDC-MN  or  MI  person.  The  requirement  to  complete 
status  reports  shall  not  apply  to  the  following: 


(1)  Persons  who  receive  Medi-Cal  through  the  Aid  for  Adoption  of 
Children  program. 

(2)  Persons  who  have  a  government  representative,  such  as  a  public 
guardian,  acting  on  their  behalf 

(3)  MI  children  who  are  not  hving  with  a  parent  or  relative  and  for 
whom  a  public  agency  is  assuming  financial  responsibility  in  whole  or 
in  part. 

(4)  Children  who  are  requesting  Medi-Cal  in  accordance  with  Section 
50147.1. 

(5)  Persons  who  receive  county  General  Assistance  Benefits  and 
whose  Medi-Cal  eligibility  factors  are  monitored  at  least  quarterly  by  the 
county  Department  under  its  general  assistance  program. 

(6)  MFBUs  consisting  solely  of  an  eligible  pregnant  woman  and/or  in- 
fant under  one  year  of  age. 

(b)  In  addition  to  the  status  reports  required  in  accordance  with  (a),  the 
county  department,  consistent  with  Article  2,  may  require  persons  or 
families  to  complete  status  reports  at  more  frequent  intervals. 
NOTE:  Authority  cited:  Sections  10725, 14016. lOand  14124.5,  Welfare  and  InsU- 
tutions  Code;  Section  133.5,  AB  251,  Chapter  102,  Statutes  of  1981.  Reference: 
Sections  14005.4.  14005.9,  14010,  14011  and  14012,  Welfare  and  Institufions 
Code. 

History 

1.  Amendment  filed  9-1-78;  effective  thirtieth  day  thereafter  (Register  78,  No. 
35). 

2.  Amendment  of  subsection  (a)(3)  filed  8-8-80;  effective  thirtieth  day  thereafter 
(Register  80,  No.  32). 

3.  Amendment  of  subsection  (a)  (4)  filed  1-8-81 ;  effecfive  thirtieth  day  thereafter 
(Register  81,  No.  2). 

4.  Amendment  of  subsection  (a)  and  new  subsection  (c)  filed  11-30-81  as  an 
emergency;  effective  upon  filing  (Register  81,  No.  49).  A  Certificate  of  Com- 
pliance must  be  transmitted  to  OAL  within  120  days  or  emergency  language 
will  be  repealed  on  3-30-82. 

5.  Certificate  of  Compliance  filed  3-30-82  (Register  82,  No.  14). 

6.  Amendment  of  subsection  (a)  and  repealer  of  subsection  (c)  filed  10-1-82  as 
an  emergency;  effective  upon  filing  (Register  82,  No.  40).  A  Certificate  of  Com- 
pliance must  be  transmitted  to  OAL  within  120  days  or  emergency  language 
will  be  repealed  on  1-29-83. 

7.  Certificate  of  CompUance  transmitted  to  OAL  12-30-82  and  filed  2-2-83 
(Register  83,  No.  6). 

8.  Editorial  correction  of  subsection  (a)  filed  7-7-83  (Register  83,  No.  29). 

9.  Editorial  correction  of  printing  error  in  subsecfion  (a)  (Register  93,  No.  35). 

10.  New  subsecfion  (a)(6)  and  amendment  of  Note  filed  4-27-94  as  an  emergen- 
cy; operative  4-27-94  (Register  94,  No.  17).  A  Certificate  of  Compliance  must 
be  transmitted  to  OAL  by  8-25-94  or  emergency  language  will  be  repealed  by 
operafion  of  law  on  the  following  day. 

1 1 .  Certificate  of  Compliance  as  to  4-27-94  order  transmitted  to  OAL  8-24-94 
and  filed  9-29-94  (Register  94,  No.  39). 

12.  Editorial  cortecnon  of  Note  (Register  94,  No.  39). 

§  50192.    Testing  Techniques  for  Redeterminations,  Status 
Reporting  and  Verification. 

(a)  Notwithstanding  Sections  50169,  50189  and  50191,  the  Director 
may,  in  counties  selected  by  the  Director,  establish  requirements  for  re- 
determinations, status  reporting,  and  verification  of  information  on  the 
Statement  of  Facts  for  the  purpose  of  testing  the  effectiveness  of  the  dif- 
ferent administrative  requirements. 

(b)  Selection  criteria  may  include,  but  shall  not  be  limited  to: 

(1)  Caseload  size. 

(2)  Past  county  adininistrative  requirements. 

(3)  Population  characteristics. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Secfions  1 0600, 1 1 004, 1 1 050, 14001, 14005.4, 14005.7, 1401 1 
and  14012,  Welfare  and  Insfitutions  Code. 

History 

1.  New  secfion  filed  9-1-78;  effective  thirtieth  day  thereafter  (Register  78,  No. 
35). 

2.  Editorial  correcfion  of  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50193.    Beginning  Date  of  Eligibility. 

(a)  The  beginning  date  of  eligibility  for  Medi-Cal  for  persons  who  ap- 
ply under  any  public  assistance  program  shall  be  the  first  day  of  the 
month  of  application,  providing  the  person  meets  the  citizenship,  resi- 
dency, hnkage  and  financial  ehgibility  criteria  of  the  appropriate  pro- 
gram, notwithstanding  the  beginning  date  of  the  cash  grant.  For  persons 


Page  336.5 


Register  2000,  No.  38;  9-22-2000 


§  50195 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


who  do  not  meet  these  eligibility  criteria  during  the  month  of  apphcation, 
the  beginning  date  of  eligibility  shall  be  the  first  day  of  the  first  month 
in  which  the  above  specified  eligibility  criteria  of  the  appropriate  pro- 
gram are  met. 

(b)  The  beginning  date  of  eligibility  for  Medi-Cal  specified  in  (a)  shall 
also  apply  to: 

(1)  Persons  who  apply  for  AFDC  and  meet  eligibility  criteria  in  the 
month  of  application  but  whose  eligibility  is  denied  because  they  no 
longer  meet  eligibility  criteria  at  the  time  eligibility  for  AFDC  is  deter- 
mined. 

(2)  Persons  who  apply  for  SSI/SSP  and  meet  the  eligibility  criteria  but 
are  denied  because  they  die  before  the  application  can  be  processed  and 
an  application  is  filed  on  their  behalf  at  the  county  department  within  30 
days  of  receipt  of  a  written  notice  of  denial. 

(c)  The  beginning  date  of  eligibility  for  persons  applying  only  for 
Medi-Cal  shall  be:  thefirstday  of  the  month  of  application,  if  all  eligibil- 
ity criteria  of  the  appropriate  Medi-Cal  program  are  met.  If  the  eligibility 
criteria  are  not  met  during  the  month  of  application,  the  beginning  date 
of  eligibility  shall  be  the  first  day  of  the  month,  subsequent  to  the  month 
of  application,  during  which  the  eligibility  criteria  of  the  appropriate 
Medi-Cal  program  are  met. 

(d)  For  the  purposes  of  (c),  eligibility  criteria  are  considered  to  be  met 
throughout  the  month  if  they  are  met  at  any  time  during  the  month,  except 
for  persons  specified  in  Section  50273(a). 

Note-.  Authority  cited:  Sections  10723  and  14124.5,  Welfare  and  Institutions 
Code.  Reference;  Sections  11014,  11016,  14005,  14018  and  J4053,  Welfare  and 
Institutions  Code. 

History 
1.  Change  without  regulatory  effect  renumbering  former  section  50701  to  new 

section  501 93  filed  9-19-2000  pursuant  to  section  1 00,  title  1 ,  California  Code 

of  Regulations  (Register  2000,  No.  38). 

§50195.    Period  of  Eligibility. 

(a)  The  period  of  eligibility  for  Medi-Cal  for  persons  eligible  for 
AFDC  or  SSI/SSP  shall  begin  with  the  date  specified  in  Section  50701 
(a)  and  (b),  and  shall  continue  through  each  successive  month  during 
which  the  person  is  determined  to  be  eligible. 

(b)  The  period  of  eligibility  for  Medi-Cal  for  persons  eligible  as  Other 
PA  recipients  shall  begin  with  the  date  specified  in  Section  50701  (c),  and 
shall  continue  through  each  successive  month  during  which  the  person 
meets  all  eligibility  requirements  of  the  appropriate  Other  PA  category. 

(c)  The  period  of  eligibility  for  Medi-Cal  for  persons  eligible  as  MN 
or  MI,  except  as  specified  in  (d),  shall  begin  with  the  date  specified  in 
Section  50701  (c),  and  shall  continue  through  each  successive  month 
during  which  the  beneficiary  meets  the  appropriate  basic  program  re- 
quirements in  Article  5  of  this  chapter  and  all  of  the  following  conditions: 

(1)  Has  cooperated  with  the  county  department  to  the  extent  required 
by  Sections  50185  and  50187. 

(2)  Has  met  the  property  requirements  specified  in  Article  9  at  some 
time  during  the  month. 

(3)  Has  met  the  citizenship,  residence  and  institutional  status  require- 
ments specified  in  Articles  6  and  7  at  some  time  during  the  month. 

(d)  The  period  of  eligibility  for  Medi-Cal  for  a  child  applying  on  his 
or  her  own  behalf  in  accordance  with  Section  50147. 1  (a)  shall  begin  with 
the  date  specified  in  Section  50701  (c),  and  shall  continue  through  each 
successive  month  during  which  the  child  meets  both  of  the  following 
conditions: 

(1)  Has  met  the  conditions  specified  in  (c). 

(2)  Has  submitted  a  completed  and  signed  form  MC  4026  to  the  county 
department  during  the  month  in  question  which  states  that  the  child  has 
a  need  for  services  related  to  sexual  assault,  daig  or  alcohol  abuse,  preg- 
nancy, family  planning  or  venereal  disease. 

(e)  The  period  of  eligibility  shall  be  modified  for  any  portion  of  a 
month  in  which  a  person  is  ineligible  due  to  institutional  status,  as  de- 
scribed in  Section  50273. 


(f)  A  final  date  of  eligibility  shall  be  established  when  the  county  de- 
partment determines  that  the  person  or  family  will  no  longer  meet  all  eh- 
gibility  requirements  as  of  the  first  of  the  following  month.  The  final  date 
shall  be  the  last  day  of  the: 

(1)  Current  month,  if  the  discontinuance  is  not  an  adverse  action  as  de- 
fined in  Section  50015. 

(2)  Current  month,  if  the  discontinuance  is  an  adverse  action  and  the 
10-day  advance  notice  requirements  of  Section  50179(e)  will  be  met  in 
the  current  month. 

(3)  Following  month,  if  the  discontinuance  is  an  adverse  action  and  the 
10-day  advance  notice  requirements  will  not  be  met  in  the  current  month. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  11014,  11016  and  14053,  Welfaie  and  Institutions 
Code. 

History 
1.  Change  without  regulatory  effect  renumbering  former  section  50703  to  new 

section  50195  filed  9-1 9-2000  pursuant  to  section  100,  title  1 ,  California  Code 

of  Regulations  (Register  2000,  No.  38). 

§  50197.    Retroactive  Eligibility. 

(a)  In  addition  to  the  period  of  eligibility  specified  in  Section  50703, 
an  applicant  shall  be  eligible  for  Medi-Cal  in  any  of  the  three  months  im- 
mediately preceding  the  month  of  application  orreapplication  if  all  of  the 
following  requirements  are  met  in  that  month: 

(1)  The  county  department  determines  that  the  applicant  would  have 
been  eligible  for  one  of  the  programs  specified  in  Section  50201,  except 
as  specified  in  (c),  had  an  application  been  made. 

(2)  The  applicant  received  heath  services. 

(3)  The  applicant  was  not  previously  denied  Medi-Cal  for  the  month 
in  question,  unless  the  application  was  denied  for  one  of  the  following 
reasons: 

(A)  County  error. 

(B)  The  applicant' s  failure  to  cooperate,  when  that  failure,  or  the  appli- 
cant's  subsequent  failure  to  reapply,  was  due  to  circumstances  beyond 
the  control  of  the  applicant. 

(b)  The  request  for  retroactive  eligibility  shall  be  made  in  accordance 
with  Section  50148  and  shall  be  treated  as  any  other  application,  except 
that  persons  applying  on  the  basis  of  disability  shall  have  their  disability 
determined  prior  to  determining  retroactive  eligibility. 

(c)  A  person  21  years  of  age  or  older  shall  not  be  retroactively  eligible 
as  a  medically  indigent  person  unless  either  of  the  following  conditions 
exist. 

(1)  The  person  was  residing  in  a  skilled  nursing  or  intermediate  care 
facility  during  any  part  of  both: 

(A)  The  month  of  application. 

(B)  The  month  for  which  retroactive  eligibility  is  requested. 

(2)  The  person  is  a  woman  with  a  confirmed  pregnancy. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4,  14019,  14019.6,  14142  arid  14145,  Welfare 
and  Institutions  Code. 

History 
1.  Change  without  regulatory  effect  renumbering  former  section  50710  to  new 

section  50197  filed  9-19-2000  pursuant  to  section  100,  title  1,  California  Code 

of  Regulations  (Register  2000,  No.  38). 

§  50199.    Certification  for  Medi-Cal— Completion. 

(a)  A  person  or  family  determined  to  be  eligible  for  Medi-Cal  shall  not 
receive  a  Medi-Cal  card  until  certified  for  Medi-Cal. 

(b)  Certification  for  Medi-Cal  shall  be  completed  by: 

(1)  The  county  department  for: 

(A)  Persons  who  have  no  share  of  cost  or  who  have  a  share  of  cost  for 
long-term  care  which  is  less  than  the  cost  of  care. 

(B)  Persons  who  have  a  share  of  cost,  other  than  those  specified  in  (A), 
and  who  complete  form  MC  1 1 3,  in  accordance  with  Section  50658  (d). 

(2)  The  Department  for  persons  who  have  a  share  of  cost,  other  than 
those  specified  in  (1)(A)  and  (B). 


Page  336.6 


Register  2000,  No.  38;  9-22-2000 


Title  22 


Health  Care  Services 


§  50203 


History 
1.  Change  without  regulatory  effect  renumbering  former  section  50715  to  new 
section  50199  filed  9-19-2000  pursuant  to  section  100,  title  1,  California  Code 
of  Regulations  (Register  2000,  No.  38). 


Article  5.     Medi-Cal  Programs 


§  50201.    Medi-Cal  Programs— General. 

(a)  A  person  or  family  may  be  eligible  for  Medi-Cal  under  one  of  the 
following  programs. 

(1)  Aid  to  Families  with  Dependent  Children  (AFDC). 

(2)  Supplemental  Security  Income/State  Supplemental  Program  (SSI/ 
SSP). 

(3)  Other  Public  Assistance  (Other  PA). 

(4)  Medically  Needy  (MN). 

(5)  Medically  Indigent  (MI). 

(6)  Miscellaneous  Special  Programs. 

(7)  Medi-Cal  Special  Treatment  Programs. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14142  and  14145,  Welfare  and  Institutions  Code. 


History 

1.  Amendment  filed  8-7-78;  effective  thirtieth  day  thereafter  (Register  78,  No. 
32). 

2.  Ameridment  filed  7-31-81  as  an  emergency;  effecfive  upon  filing  (Register  81 , 
No.  33).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  1 1-28-81. 

3.  Certificate  of  Compliance  transjnitted  to  OAL  11-6-81  and  filed  1-27-82 
(Register  82,  No.  5). 

4.  Amendment  filed  7-19-82;  effective  thirtieth  day  thereafter  (Register  82,  No. 
30). 

§  50203.    Medically  Needy  Program. 

(a)  A  person's  eligibility  shall  be  determined  under  the  Medically 
Needy  program  if  that  person  is  any  of  the  following: 

(1)  An  aged,  Wind  or  disabled  person  who  meets  one  of  the  following 
conditions: 

(A)  Is  not  eligible  for  or  does  not  want  to  receive  assistance  as  a  PA 
or  Other  PA  recipient. 

(B)  Has  an  application  pending  for  SSI/SSP. 

(2)  A  child  or  family  member  who  is  both: 

(A)  Linked  to  AFDC  in  accordance  with  Section  50205. 

(B)  Not  ehgible  for  or  does  not  want  to  receive  assistance  as  a  PA  or 
Other  PA  recipient. 


[The  next  page  is  337.] 


Page  336.7 


Register  2000,  No.  38;  9-22-2000 


Title  22 


Health  Care  Services 


§  50213 


• 


(3)  A  caretaker  relative  who  chooses  to  be  included  in  a  child's  MFBU 
in  accordance  with  Section  50373  (a)(5)  (A)  13  or  when  all  children  are 
PA  or  other  PA. 

(b)  A  person  who  meets  the  conditions  of  more  than  one  of  the  follow- 
ing categories  shall  have  eligibility  determined  on  the  basis  of  the  catego- 
ry listed  first  unless  the  person  requests  otherwise: 

(1)  Blindness,  as  defined  in  Section  50219. 

(2)  Age,  as  defined  in  Section  50221. 

(3)  Disability,  as  defined  in  Section  50223. 

(4)  Linkage  to  AFDC,  as  defined  in  Section  50205. 

(c)  In  order  to  be  eligible  under  this  program  the  persons  listed  in  (a) 
shall  meet  the  property,  citizenship,  residence,  institutional  status  and 
cooperation  requirements  specified  in  these  regulations. 

(d)  In  order  to  be  certified  and  receive  a  Medi-Cal  card  under  this  pro- 
gram, the  persons  listed  in  (a)  shall  be  determined  eligible  and  meet  the 
income  and  share-of-cost  requirements  specified  in  these  regulations. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14005.3  and  14005.7,  Welfaie  and  Institutions  Code. 

HtSTORY 

1 .  Repealer  and  new  section  filed  3-7-80  as  an  emergency;  effective  upon  filing 
(Register  80,  No.  9).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL 
within  120  days  or  emergency  language  will  be  repealed  on  7-6-80. 

2.  Certificate  of  Compliance  filed  6-6-80  (Register  80,  No.  23). 

3.  Amendment  of  subsection  (a)  filed  2-11-82;  effective  thirtieth  day  thereafter 
(Register  82,  No.  7). 

4.  Change  without  regulatory  effect  of  subsection  (a)(3)  (Register  87,  No.  11). 

5.  Amendment  of  subsecfion  (a)  and  repealer  of  subsection  (e)  filed  4-17-89;  op- 
erative 5-17-89  (Register  89,  No.  48). 

§  50205.     Linkage  to  AFDC. 

(a)  Linkage  to  AFDC  exists  if  a  child  is  living  with  a  relative  and  de- 
prived of  parental  support  or  care.  Deprivation  shall  be  established  if  all 
conditions  of  any  one  of  the  following  sections  are  met  at  any  time  during 
the  month: 

(1)  Deprivation — Deceased  Parent,  section  50209. 

(2)  Deprivation — Physical  or  Mental  Incapacity  of  Parent,  Section 
50211. 

(3)  Deprivation — Absent  Parent,  Section  50213. 

(4)  Deprivation — Unemployed  Parent,  Section  50215. 

(b)  A  child  who  is  deprived  of  parental  support  or  care  for  more  than 
one  reason,  may  have  linkage  to  AFDC  established  on  any  basis  of  depri- 
vation that  is  listed  in  (a).  The  advantages  and  disadvantages  of  each  basis 
shall  be  explained  to  the  applicant  or  beneficiary  and  the  basis  of  depriva- 
tion shall  be  the  choice  of  the  child's  parent  or  caretaker  relative. 

(c)  All  family  members  living  in  the  home,  except  those  children  ex- 
cluded from  the  MFBU  in  accordance  with  Section  50381  and  children 
who  are  ineligible  for  Medi-Cal,  shall  be  considered  in  determining 
whether  linkage  to  AFDC  exists.  Family  members  also  include  persons 
who  are  PA  or  other  PA  recipients. 

Note-.  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4, 14005.7, 14051  and  14052,  Welfare  and  Insti- 
tutions Code. 

History 

1 .  Amendment  filed  3-7-80;  effecU  ve  thirtieth  day  thereafter  (Register  80,  No.  9). 

2.  New  subsecfion  (d)  filed  1-8-81 ;  effecfive  thirtieth  day  thereafter  (Register  81, 
No.  2). 

3.  Amendment  filed  3-24-82;  effective  thirtieth  day  thereafter  (Register  82,  No. 
13). 

4.  Amendment  of  subsections  (b)  and  (c)  filed  6-3-87;  operative  7-3-87  (Register 
87,  No.  24). 

§  50207.    Deprivation — Relinquishment  for  Adoption. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Insfitutions 
Code.  Reference:  Sections  14005.4, 14005.7, 14051  and  14052,  Welfare  and  Insfi- 
tutions Code. 

History 
1.  Repealer  filed  3-24-82;  effective  thirtieth  day  thereafter  (Register  82,  No.  13). 

§  50209.    Deprivation — Deceased  Parent. 

(a)  Deprivation  of  parental  support  or  care  exists  if  either  of  the  child's 
parents  is  deceased. 


(b)  Children  of  a  deceased  parent  and  the  remaining  parent  living  with 
the  child  shall  be  linked  to  AFDC  on  the  basis  of  this  deprivation  factor. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14001.1  and  14005.7,  Welfare  and  Institutions  Code. 

History 
1.  Editorial  conection  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  5021 1 .    Deprivation — Physical  or  Mental  Incapacity  of  a 
Parent. 

(a)  Deprivation  of  parental  support  or  care  exists  if  either  of  the  child's 
parents  is  physically  or  mentally  incapacitated. 

(b)  A  parent  is  incapacitated  if  such  parent  has  a  physical  or  mental  il- 
lness, defect  or  impairment  that  is  expected  to  last  at  least  30  days,  is  veri- 
fiable in  accordance  with  Section  50167,  and  does  either  of  the  follow- 
ing: 

(1)  Reduces  substantially  or  eliminates  the  parent's  ability  to  support 
or  care  for  the  child. 

(2)  Causes  one  of  the  following  situations: 

(A)  The  parent  is  prevented  from  working  full-time  at  a  job  in  which 
customarily  engaged,  and  from  working  full-time  on  another  job  for 
which  equipped  by  education,  training  or  experience  or  which  could  be 
learned  by  on-the-job  training. 

(B)  Employers  refuse  to  employ  the  parent  for  work  the  parent  could 
do  and  is  willing  to  do,  because  of  behavioral  or  other  disorders  which 
interfere  with  the  securing  and  maintaining  of  employment. 

(C)  The  parent  is  prevented  from  accomplishing  as  much  on  a  job  as 
a  regular  employee  and,  as  a  result,  is  paid  on  a  reduced  basis. 

(D)  The  parent  is  blind  or  disabled  in  accordance  with  Section 
50223(a)(1)  or  (b). 

(E)  The  parent  has  qualified  for  and  is  employed  in  a  job  which  is  reha- 
bilitative or  therapeutic  or  is  in  a  sheltered  workshop,  and  which  is  not 
considered  to  be  full-time. 

(c)  The  following  persons  shall  be  linked  to  AFDC  on  the  basis  of  this 
deprivarion  factor: 

(1)  The  children  of  an  incapacitated  parent. 

(2)  The  incapacitated  parent. 

(3)  The  spouse  of  the  incapacitated  parent  or  the  second  parent  of  the 

children  whose  basis  of  deprivation  is  an  incapacitated  parent. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.3,  14005.7  and  14051,  Welfare  and  Institutions 
Code. 

History 

1.  Amendment  of  subsection  (b)(2)(D)  filed  3-7-80  as  an  emergency;  effective 
upon  filing  (Register  80,  No.  9).  A  Certificate  of  Compliance  must  be  trans- 
mitted to  OAH  within  120  days  or  emergency  language  will  be  repealed  on 
7-6-80. 

2.  Certificate  of  Compliance  filed  6-6-80  (Register  80,  No.  23). 

3.  Amendment  of  subsection  (b)(2)(A)  filed  8-8-80;  effective  thirtieth  day  there- 
after (Register  80,  No.  32). 

4.  Amendment  of  subsection  (c)  filed  1-8-81;  effective  thirtieth  day  thereafter 
(Register  81,  No.  2). 

5.  Amendment  of  subsection  (b)  filed  1 1-20-96;  operative  12-20-96  (Register 
96,  No.  47). 


§  50213.    Deprivation — Absent  Parent. 

(a)  Deprivation  of  parental  support  or  care  exists  if  there  is  continued 
absence  of  one  or  both  of  a  child's  parents  from  the  home. 

(b)  Deprivation  does  not  exist  when  one  or  both  of  the  parents  is  absent 
from  the  home  on  a  temporary  basis,  such  as  for  a: 

(1)  Visit. 

(2)  Trip. 

(3)  Temporary  assignment  undertaken  in  connection  with  current  or 
prospective  employment. 

(4)  Parental  absence  due  solely  to  active  duty  in  the  uniformed  services 
of  the  United  States.  Uniformed  services  means  the  Army,  Navy,  Air 
Force,  Marine  Corps,  Coast  Guard,  National  Oceanographic  and  Atmo- 
spheric Administration  and  Public  Health  Service  of  the  United  States. 


Page  337 


Register  96,  No.  47;  11-22-96 


§  50215 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


(c)  Continued  absence  shall  be  considered  to  exist  wiien  a  parent  is 
physically  absent  from  the  home  and  both  otthe  following  conditions  ex- 
ist: 

(1 )  The  nature  of  the  absence  results  in  an  interruption  or  termination 
of  the  parent's  functioning  as  a  provider  of  maintenance,  physical  care, 
or  guidance  for  the  child,  regardless  of  the  reason  for  the  absence  or  the 
length  of  time  the  parent  has  been  absent. 

(2)  The  known  or  indefinite  duration  of  the  absence  precludes  count- 
ing on  the  parent's  performance  of  the  function  of  planning  for  the  pres- 
ent support  or  care  of  the  children. 

(d)  When  the  conditions  specified  in  (c)  exist,  regular  or  frequent  visits 
with  the  child  by  a  parent  who  is  physically  absent  from  the  home  shall 
not  in  and  of  itself  prevent  a  determination  that  "continued  absence"  ex- 
ists. "Continued  absence"  shall  be  considered  to  exist  when  the  child 
lives  with  each  parent  for  alternating  periods  of  time. 

(e)  If  the  parent  in  the  home  has  stated  on  the  Statement  of  Facts  that 
the  other  parent  has  left  the  family,  this  shall  be  considered  to  mean  that 
there  is  continued  absence  unless  the  county  department  has  conflicting 
information.  In  the  case  of  conflicting  information,  the  written  statement 
shall  be  supported  by  at  least  one  of  the  following: 

(1)  Written  statements  of  the  absent  parent  or  other  persons  with  prior 
knowledge  of  the  family  relationship. 

(2)  The  actions  of  the  applicant  or  beneficiary  or  the  absent  parent 
clearly  indicate: 

(A)  Physical  absence  of  the  other  parent. 

(B)  Interruption  of  or  marked  reduction  in  marital  and  family  responsi- 
bilities. 

(3)  Other  evidence  that  substantiates  continued  absence. 

(f)  Absence  of  a  parent  on  active  duty  in  the  Armed  Forces  may  or  may 
not  constitute  deprivation,  dependent  upon  whether  or  not  the  facts  in  the 
individual  case  indicate  an  interruption  of,  or  marked  reduction  in,  mari- 
tal and  family  responsibilities.  The  county  department  shall  determine  if 
deprivation  exists  by  examining  each  case  individually  in  light  of  all  rele- 
vant factors,  including: 

(1)  Length  of  absence. 

(2)  Assignment  to  a  duty  station  to  which  the  family  may  not  move. 

(3)  The  financial  impact  on  the  family,  if  the  parent  may  be  accompa- 
nied to  that  station. 

(4)  The  extent  of  family  disruption  that  would  be  caused  if  family 
members  would  have  to  give  up  employment  to  accompany  the  parent  to 
the  assigned  duty  station. 

(g)  Children  of  an  absent  parent,  and  the  parent  in  the  home,  shall  be 
linked  to  AFDC  on  the  basis  of  this  deprivation  factor.  If  the  parent  in  the 
home  is  married,  and  the  spouse  also  has  children  from  a  prior  union,  the 
following  persons  shall  be  linked  to  AFDC: 

(1)  The  children  of  each  parent,  other  than  mutual  children. 

(2)  Both  parents. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4,  14005.7  and  14051,  Welfare  and  Institutions 
Code. 

History 

1 .  Amendment  of  subsection  (f)(2)  filed  10-24-86;  effective  thirtieth  day  thereaf- 
ter (Register  86,  No.  43). 

2.  Amendment  of  subsection  (b),  repealer  of  subsection  (e)  and  relettering  of  sub- 
section (f)  to  subsection  (e)  filed  7-9-87;  operative  8-8-87  (Register  87,  No. 
30). 

3.  Amendment  of  subsections  (c)-(f)  filed  4-17-89;  operative  5-17-89  (Register 
89,  No.  48). 

§  50215.    Deprivation — Unemployed  Parent. 

(a)  Deprivation  of  parental  support  or  care  exists  if  a  parent  with  whom 
the  the  child  lives  is  any  of  the  following  as  limited  by  (b),  (c)  and  (d): 

(1)  Not  working. 

(2)  Working  less  than  100  hours  a  month. 

(3)  Employed  on  an  intermittent  basis  more  than  100  hours  per  month 
and  the  hours  in  excess  of  100  hours  are  of  a  temporary  nature.  Tempo- 
rary nature  is  shown  if  the  parent  was  under  the  100  hour  standard  for  the 


two  prior  calendar  months  and  is  expected  to  be  under  the  standard  during 
the  next  month. 

(4)  Unemployed  and  has  been  accepted  for  or  is  participating  in  an 
education  or  training  program  essential  to  future  self-support  which  is  all 
of  the  following: 

(A)  Directed  toward  a  specific  occupation  and  will  qualify  the  unem- 
ployed person  for  an  occupation  in  demand  in  the  local  area. 

(B)  A  program  which  will  be  completed  by  the  unemployed  person 
within  a  maximum  of  two  years. 

(C)  Not  a  program  which  involves  post  baccalaureate  work. 

(b)  For  deprivation  due  to  unemployment  to  exist,  the  unemployed 
parent  must  meet  all  of  the  following  conditions: 

(1)  Is  the  principal  wage  earner  as  determined  in  accordance  with  (c). 

(2)  Has  not  been  employed,  or  has  worked  less  than  100  hours,  in  the 
last  30  days. 

(3)  Is  available  for  and  actively  seeking  employment. 

(4)  Has  not,  without  good  cause,  within  the  last  30  days  either: 

(A)  Quit  a  job  or  employment  related  training. 

(B)  Refused  a  bona  fide  offer  of  employment  or  employment  related 
training. 

(5)  Possesses,  or  has  applied  for,  a  Social  Security  number. 

(6)  Has  not  refused  to  apply  for  and  accept  any  unemployment  insur- 
ance benefits  (UIB)  to  which  he  is  entitled. 

(7)  Has  established  a  connection  with  the  labor  force  in  either  of  the 
following  ways: 

(A)  By  meeting  one  of  the  following  requirements  in  6  calendar  quar- 
ters within  any  1 3  calendar  quarter  period  ending  within  the  year  prior 
to  the  month  of  application  for  Medi-Cal: 

1 .  Earns  a  gross  income  of  at  least  $50  during  the  quarter. 

2.  Participated  for  at  least  five  days  during  the  quarter  in  any  activity 
administered  under  any  of  the  following: 

a.  The  Work  Incentive  (WIN)  program. 

b.  The  Work  Incentive  Demonstration  Program  (WIN  Demo). 

c.  The  Community  Work  Experience  Program  (CWEP). 

d.  The  Greater  Avenues  for  Independence  (GAIN)  Program. 

3.  A  combination  of  1.  and  2. 

(B)  By  having  received,  or  having  been  eligible  to  receive,  UIB  within 
the  year  prior  to  the  month  of  application.  A  person  is  eligible  to  receive 
UIB  if  either  of  the  following  conditions  is  met: 

1.  The  person  would  have  been  eligible  to  receive  unemployment 
compensation  upon  filing  an  application. 

2.  The  person  performed  work  not  covered  by  Unemployment  Com- 
pensation Law,  and  the  coverage  of  such  work,  if  combined  with  any  cov- 
ered work,  would  create  eligibility  to  receive  unemployment  compensa- 
tion upon  filing  an  application. 

(8)  Is  not  unemployed  throughout  the  month  as  a  result  of  participation 
in  a  labor  dispute. 

(c)  The  principal  wage  earner  is  the  parent  who  has  earned  the  greater 
amount  of  income  in  the  24  month  period  immediately  preceding  either 
of  the  following: 

(1)  The  month  of  application,  reapplication  or  restoration. 

(2)  The  date  of  a  redetermination  that  a  family's  circumstances  have 
changed  in  such  a  way  as  to  meet  the  requirements  for  deprivation  due 
to  the  unemployment  of  a  parent. 

(d)  The  following  persons  shall  be  linked  to  AFDC  on  the  basis  of  this 
deprivation  factor: 

(1)  The  children  of  the  unemployed  parent. 

(2)  The  unemployed  parent. 

(3)  The  second  parent  of  the  children  whose  basis  of  deprivation  is  un- 
employed parent. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4,  14005.7  and  14051,  Welfare  and  Institutions 
Code. 

History 

1 .  Amendment  of  subsections  (a)(4)  and  (f)  filed  12-1 5-77 ;  effective  thirtieth  day 
thereafter  (Register  77,  No.  51). 

2.  Amendment  filed  1-8-8 1 ;  effective  thirtieth  day  thereafter  (Register  81,  No.  2). 


Page  338 


Register  96,  No.  47;  11-22-96 


Title  22 


Health  Care  Services 


§  50227 


• 


3.  Amendment  filed  4-2-82  as  an  emergency;  effective  upon  filing  (Register  82, 
No.  14).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  7-31-82. 

4.  Certificate  of  Compliance  transmitted  to  OAL  within  120  days  and  filed 
8-10-82  (Register  82.  No.  33). 

5.  Repealer  of  subsection  (b)  (8)  and  relettering  of  subsection  (b)  (9)  to  subsection 
(b)(8)  filed  12-8-83;  effective  thirtieth  day  thereafter  (Register  83,  No.  50). 

6.  Amendment  of  subsection  (b)  (7)  (A)  filed  10-24-86;  effective  thirtieth  day 
thereafter  (Register  86,  No.  43). 

7.  Amendment  of  subsection  (c)  filed  4-17-89;  operative  5-17-89  (Register  89, 

No.  48). 

8.  Editorial  conection  of  printing  error  in  subsections  (d)(2)  and  (d)(3)  (Register 
93,  No.  13). 

§  50216.    Good  Cause — Refusal  of  Employment. 

(a)  Good  cause  for  refusal  of  employment  or  training  or  for  quitting  a 
job  or  training  as  required  in  Section  50215  (b),  shall  be  found  if  the  appli- 
cant or  beneficiary  refuses  or  quits  for  any  of  the  following  reasons: 

(1)  The  offer  of  employment  was  from  an  employer  who  did  not: 

(A)  Possess  an  appropriate  license  to  engage  in  business. 

(B)  Withhold  or  hold  in  trust  the  employee  contributions  required  by 
Part  2  of  Division  1  of  the  Unemployment  Insurance  Code,  Section  2601 
et  seq.,  for  unemployment  compensation  disability  benefits  and  does  not 
transmit  all  such  employee  contributions  to  the  Department  of  Social  Ser- 
vices as  required  by  Section  986  of  the  Unemployment  Insurance  Code. 

(C)  Carry  either  workers'  compensation  insurance  or  possess  a  certifi- 
cate of  self-insurance  as  required  by  Division  4  of  the  Labor  Code,  Sec- 
tion 3201  et  seq. 

(2)  The  employment  or  training  violated  applicable  health  and  safety 
laws  and  regulations. 

(3)  The  wage  offered  for  the  employment  or  training  was  less  than  the 
applicable  state  or  federal  minimum  wage  or  was  lower  than  the  custom- 
ary wage  in  the  community  for  that  particular  employment  or  training  as 
set  by  the  Employment  Development  Department,  whichever  is  higher. 

(4)  The  acceptance  of  employment  would  preclude  completion  of  a 
job  training  or  educational  program  approved  by  the  state  or  county. 

(5)  The  employment  or  training  was  in  excess  of  the  individual's  men- 
tal or  physical  capacity. 

(6)  The  individual  was  ill  or  required  to  care  for  an  ill  member  of  the 
immediate  family  and  no  other  care  arrangements  were  feasible. 

(7)  Child  care  arrangements  could  not  be  made. 

(8)  The  individual  was  without  a  means  of  getting  to  or  from  the  place 
of  employment  or  training. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.7  and  14051,  Welfare  and  Institutions  Code. 

History 

1 .  Amendment  filed  12-15-77;  effective  thirtieth  day  thereafter  (Register  77,  No. 
51). 

2.  Repealer  of  subsection  (a)(5)  and  consecutive  renumbering  of  subsections 
(a)(6)-(a)(9)  to  subsections  (a)(5)-(a)(8)  filed  4-2-82  as  an  emergency;  effec- 
tive upon  filing  (Register  82,  No.  14).  A  Certificate  of  Compliance  must  be 
transmitted  to  OAL  within  120  days  or  emergency  language  will  be  repealed  on 
7-31-82. 

3.  Certificate  of  Compliance  transmitted  to  OAL  within  120  days  and  filed 
8-10-82  (Register  82,  No.  33). 

4.  Editorial  correction  of  subsections  (a)  and  (a)(1)(B)  filed  7-7-83  (Register  83, 
No.  29). 

§  50216.5.    Linkage  to  AFDC — Placement  in  Foster  Care. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4, 14005.7,  14051,  and  14052,  Welfare  and  In- 
stitutions Code. 

History 

1 .  New  section  filed  3-7-80;  effective  thirtieth  day  thereafter  (Register  80,  No.  9). 

2.  Amendment  of  subsection  (a)  filed  1-8-81;  effective  thirtieth  day  thereafter 
(Register  81,  No.  2). 

3.  Repealer  filed  3-24-82;  effective  thirtieth  day  thereafter  (Register  82,  No.  13). 

§  5021 7.    Linkage  to  SSI/SSP. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14005.3,  Welfare  and  Institutions  Code. 


History 

1 .  Repealer  filed  3-7-80  as  an  emergency;  effective  upon  filing  (Register  80,  No. 
9).  A  Certificate  of  Compliance  must  be  transmitted  to  OAH  within  120  days 
or  emergency  language  will  be  repealed  on  7-6-80. 

2.  Certificate  of  Compliance  filed  6-6-80  (Register  80,  No.  23). 

§50219.     Blindness. 

(a)  Persons  shall  be  considered  to  be  blind  if  there  has  been  a  medical 
determination  that  they  have  either  of  the  following  conditions: 

(1)  Central  visual  acuity  of  no  more  than  20/200  with  correction. 

(2)  Tunnel  vision,  which  is  a  limited  visual  field  of  20  degrees  or  less. 

§50221.     Age. 

(a)  Persons  are  aged  if  they  are  65  years  of  age  or  older.  Persons  are 
considered  to  be  65  years  of  age  on  the  first  day  of  the  month  in  which 
they  reach  age  65. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.3,  14005.7  and  14050.1,  Welfare  and  Institu- 
tions Code. 

History 
1 .  Editorial  cortection  adding  NOTE  filed  7-7-83  (Register  83,  No.  29). 

§  50223.     Disability. 

(a)  Persons  1 8  years  of  age  or  over  are  disabled  if  they  meet  the  defini- 
tion in  (1)  or  the  definition  in  (2): 

(1)  Federally  disabled  persons  are  persons  who  meet  the  definition  of 
disability  in  Title  II  or  Title  XVI,  Social  Security  Act. 

(2)  SGA-disabled  persons  are  persons  who  were  once  determined  to 
be  disabled  in  accordance  with  the  provisions  of  the  SSI/SSP  program 
(Section  1614,  Part  A,  Title  XVI,  Social  Security  Act)  and  meet  both  the 
following  conditions: 

(A)  Were  eligible  for  SSI/SSP  but  became  ineligible  because  of  en- 
gagement in  substantial  gainful  activity  as  defined  in  Title  XVI  regula- 
tions. 

(B)  Continue  to  suffer  from  the  physical  or  mental  impairment  which 
was  the  basis  of  the  disability  determination. 

(b)  Children  who  are  under  18  years  of  age  shall  be  considered  to  be 
disabled  if  they  have  any  medically  determinable  physical  or  mental  im- 
pairment of  comparable  severity  to  that  which  would  make  an  adult  dis- 
abled in  accordance  with  (a)(1)  or  (2). 

(c)  Eligibility  or  share  of  cost  determinations  effective  on  or  after  Jan- 
uary 1 ,  1980  shall  be  based  on  the  provisions  of  this  Section. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14005.3,  Welfare  and  Institutions  Code. 

History 

1.  Amendment  filed  3-7-80  as  an  emergency;  effecfive  upon  filing  (Register  80, 
No.  9).  A  Certificate  of  Compliance  must  be  transmitted  to  OAH  within  120 
days  or  emergency  language  will  be  repealed  on  7-6-80. 

2.  Certificate  of  Compliance  filed  6-6-80  (Register  80,  No.  23). 

3.  Amendment  of  subsection  (a)(1)  filed  7-2-80  effective  thirtieth  day  thereafter 
(Register  80,  No.  27). 

§  50227.    Public  Assistance  Cash  Grant  Programs. 

(a)  Public  assistance  cash  grant  programs  include  the  following  pro- 
grams: 

(l)AFDC. 

(2)  SSI/SSP. 

(3)  Cuban  Refugee  Cash  Grant. 

(4)  Indochinese  Refugee  Cash  Grant. 

(5)  Emergency  Assistance  (EA). 

(b)  Except  as  provided  in  (d)  and  (e)  below,  persons  receiving  a  cash 
grant  under  any  one  of  the  programs  specified  in  (a)  shall  automatically 
receive  a  Medi-Cal  card  for  each  month  in  which  they  receive  the  cash 
grant. 

(c)  Except  as  provided  in  (d)  and  (e)  below,  persons  not  currently  in 
receipt  of  a  cash  grant  under  one  of  the  programs  specified  in  (a),  shall 
automatically  receive  a  Medi-Cal  card  for  each  month  in  which  they  are 
ineligible  for  the  cash  grant  because  of  either  of  the  following  reasons: 

(1)  Their  cash  grant  has  been  suspended  for  an  administradve  reason 
such  as  to: 

(A)  Determine  the  amount  of  the  cash  grant. 


Page  339 


Register  94,  No.  39;  9-30-94 


§  50237 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


(B)  Adjust  an  overpayment. 

(C)  Change  the  recipient's  representative  payee. 

(2)  They  are  in  the  Zero  Basic  Grant  category  because  the  net  income 
of  the  family  exceeds  the  AFDC  payment  standard  but  does  not  exceed 
the  Minimum  Basic  Standard  of  Adequate  Care  (MBSAC). 

(d)  Persons  who  (1)  fail  to  assign  to  the  state  their  rights  or  the  rights 
of  individuals  for  whom  they  can  legally  assign  rights  to  medical  support 
and/or  (2)  fail  to  cooperate,  without  good  cause,  in  identifying  and  pro- 
viding information  regarding  any  other  coverage  or  any  third  party  who 
is  or  may  be  liable  to  pay  for  medical  coverage,  care,  services,  or  support 
payments  (including  individuals  required  to  cooperate  in  the  establish- 
ment of  paternity)  shall  be  ineligible  for  Medi-Cal. 

(e)  Persons  shall  not  be  considered  Public  Assistance  recipients  for 
purposes  of  Medi-Cal  ehgibility  when  the  following  conditions  exist. 
The  person  is  both: 

(1)  Age  21  years  or  older. 

(2)  Receiving  AFDC  for  which  federal  financial  participation  is  not 
obtainable  or  EA  as  part  of  an  unemployed  parent  family. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  and  Section  87,  Chapter  1594,  Statutes  of  1982,  SB  2012.  Reference:  Sec- 
tions 1 1250.5,  1 1406.5,  14005.1  and  14008.6,  Welfare  and  Institutions  Code;  and 
42  C.F.R.  Sections  433.135,  433.136.  433.137,  433.138,  433.145,  433.146, 
433.147,  433.148  and  435.604. 

History 

1.  Amendment  of  subsection  (a)  filed  8-7-78;  effective  thirtieth  day  thereafter 
(Register  78,  No.  32). 

2.  Amendment  of  subsection  (a)  filed  7-31-81  as  an  emergency;  effective  thirtieth 
day  thereafter  (Register  81,  No.  33).  A  Certificate  of  Compliance  must  be  trans- 
mitted to  OAL  within  120  days  or  emergency  language  will  be  repealed  on 
11-28-81. 

3.  Certificate  of  Compliance  transmitted  to  OAL  11-6-81  and  filed  1-27-82 
(Register  82,  No.  5). 

4.  Amendment  of  subsections  (a)  and  (b)  and  new  subsecfion  (d)  filed  12-31-82 
as  an  emergency;  effective  upon  filing  (Register  83,  No.  2).  A  Certificate  of 
Compliance  must  be  transmitted  to  OAL  within  120  days  or  emergency  lan- 
guage will  be  repealed  on  4-30-83. 

5.  Certificate  of  Compliance  transmitted  to  OAL  4-13-83  and  filed  5-16-83 
(Register83,  No.  21). 

6.  Editorial  correction  of  Note  filed  5-16-83  (Register  83,  No.  21). 

7.  Amendment  of  subsections  (b)  and  (c)  and  Note,  new  subsecfion  (d)  and  sub- 
secfion relettering  filed  4-16-93  as  an  emergency;  operative  4-16-93  (Register 
93,  No.  1 6).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  8-16-93 
or  emergency  language  will  be  repealed  by  operation  of  law  on  the  following 
day. 

8.  Certificate  of  Compliance  as  to  4-16-93  order  including  amendment  of  Note 
transmitted  to  OAL  8-13-93  and  filed  9-23-93  (Register  93,  No.  39). 

§  50237.    Other  Public  Assistance  Program. 

(a)  The  Other  Public  Assistance  Program  consists  of  categories  of 
Medi-Cal  beneficiaries  defined  in  Sections  50243  through  50247.  Ex- 
cept as  specified  in  Sections  50243  through  50247,  individuals  applying 
for  Medi-Cal  under  any  of  the  Other  Public  Assistance  Program  catego- 
ries shall  meet  all  of  the  requirements  of  AFDC  or  SSI/SSP. 
NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.1,  14005.7,  and  14050.1,  Welfare  and  Institu- 
tions Code. 

History 

1.  Amendment  filed  8-7-78;  effective  thirtieth  day  thereafter  (Register  78,  No. 

32). 

2.  Amendment  filed  7-31-81  as  an  emergency;  effecUve  upon  filing  (Register  81, 
No.  33).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  1 1-28-81. 

3.  Certificate  of  Compliance  transmitted  to  OAL  11-6-81  and  filed  1-27-82 
(Register  82,  No.  5). 

4.  Amendment  filed  4-2-82  as  an  emergency;  effective  upon  filing  (Register  82, 
No.  14).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  7-31-82. 

5.  Certificate  of  Compliance  transmitted  to  OAL  within  120  days  and  filed 
8-10-82  (Register  82,  No.  33). 

§  50241 .    Children  Not  in  School  or  Training. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  InsUtutions 
Code.  Reference:  Sections  14005.1,  14005.7  and  14050.1,  Welfare  and  Institu- 
tions Code. 


History 

1 .  Repealer  filed  4-2-82  as  an  emergency;  effective  upon  filing  (Register  82,  No. 
14).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  7-31-82. 


§  50243.    Four  Month  Continuing  Eligibility. 

(a)  The  Four  Month  Continuing  category  includes  persons  who  were: 

(1)  Discontinued  from  AFDC  due  solely  to  increased  earnings  from 
employment  or  increased  hours  of  einployment  of  a  child  in  or  added  to 
the  AFDC  unit  or  a  parent  of  a  child  or  added  to  the  filing  unit,  and  were 
meinbers  of  a  family  receiving  an  AFDC  cash  grant  or  eligible  under  Sec- 
tion 50227  (c)(1)  in  at  least  three  of  the  six  months  immediately  prior  to 
the  month  they  became  ineligible  for  AFDC. 

This  Four  Month  Continuing  category  does  not  include  persons  who 
were  discontinued  from  AFDC  due  to  any  of  the  following: 

(A)  A  stepparent  contribution. 

(B)  An  increase  in  a  stepparent  contribution. 

(C)  The  return  of  an  absent  parent  to  the  home  which  ends  deprivation. 

(D)  The  stepparent's  abihty  to  meet  the  needs  of  the  parent. 

(E)  The  expiration  of  the  $30  plus  1/3  or  $30  earned  income  disregard. 

(2)  Discontinued  from  AFDC  due  (wholly  or  in  part)  to  the  collection 
or  increased  collection  of  child/spousal  support,  beginning  August  1, 
1984  and  ending  September  30,  1988  providing  such  persons  were  re- 
ceiving an  AFDC  cash  under  Section  50227  (c)(1)  in  at  least  three  of  the 
six  months  prior  to  the  month  they  became  ineligible  for  AFDC. 

(b)  Eligibility  for  Four  Month  Continuing  based  on  increased  earnings 
or  hours  of  employment  shall  continue  for  a  period  of  four  months  fol- 
lowing the  most  recent  month  in  which  the  family  became  ineligible  for 
AFDC,  providing  that  the  family  maintains  California  residency  and  a 
family  member  continues  to  be  employed. 

(c)  Eligibility  for  Four  Month  Continuing  based  (wholly  or  in  part)  on 
the  collection  or  increased  collection  of  child/spousal  support  shall  con- 
tinue for  a  period  of  four  months  following  the  most  recent  month  in 
which  the  family  became  ineligible  for  AFDC. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  InsUtutions 
Code.  Reference:  Sections  14005.1  and  14050.1,  Welfare  and  InsUtutions  Code. 

History 

1 .  Amendment  filed  3-7-80;  effective  thirtieth  day  thereafter  (Register  80,  No.  9). 

2.  Amendment  of  subsection  (a)(1),  (b)  -  (d)  filed  4-15-85  as  an  emergency;  ef- 
fective upon  filing  (Register  85,  No.  16).  A  Certificate  of  Compliance  must  be 
transmitted  to  OAL  within  1 20  days  or  emergency  language  will  be  repealed  on 
8-13-85. 

3.  Certificate  of  Compliance  including  amendment  transmitted  to  OAL  8-13-85 
and  filed  9-18-85  (Register  85,  No.  38). 

4.  Amendment  filed  9-11-87;  operative  10-1 1-87  (Register  87,  No.  37). 

5.  Amendment  of  subsection  (b)  filed  4-17-89;  operafive  5-17-89  (Register  89, 
No.  48). 

6.  Certificate  of  Compliance  filed  9-12-79  (Register  79,  No.  37). 


§  50244.    Nine  Month  Continuing  Eligibility. 

(a)  The  Nine  Month  Continuing  category  includes  persons  who  were 
discontinued  from  AFDC  due  solely  to  the  expiration  of  the  $30  plus  1/3 
or  $30  earned  income  disregard  specified  under  that  program. 

(b)  Eligibility  under  this  category  shall  continue  for  a  period  of  nine 
consecutive  months  following  the  most  recent  month  in  which  the  fanuly 
became  ineligible  for  AFDC,  regardless  of  whether  the  other  conditions 
of  eligibility  are  met. 

(c)  The  provisions  of  this  regulation  also  apply  to  eligibility  determi- 
nations or  redeterminations  made  retroactively  to  October  1,  1984. 
NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  InsUtutions 
Code;  Section  14,  AB  1557,  Chapter  1447,  Statutes  of  1984.  ELeference:  Section 
14005.8,  Welfare  and  Institutions  Code. 

History 

1.  New  section  filed  4-15-85  as  an  emergency;  effective  upon  filing  (Register  85, 
No.  16).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  8-13-85. 


Page  340 


Register  94,  No.  39;  9-30-94 


Title  22 


Health  Care  Services 


§  50251 


• 


• 


2.  Certificate  of  Compliance  including  amendment  of  subsection  (a)  transmitted 
to  OAL  8-13-85  and  filed  9-18-85  (Register  85,  No.  38). 

§  50245.     In-Home  Supportive  Services  (IHSS). 

(a)  A  person  shall  be  eligible  under  the  In-Home  Supportive  Services 
({HSS)  category  if  the  person  is  receiving  IHSS  as  defined  in  the  social 
services  regulations  of  the  Department  of  Social  Services  and  all  of  the 
requirements  in  either  (1)  or  (2)  are  met: 

(1)  The  person: 

(A)  Is  eligible  for  SSI/SSP  but  does  not  wish  to  apply  or  would  be  eligi- 
ble for  SSI/SSP  except  that  the  person's  income  is  in  excess  of  the  SSI/ 
SSP  payment  level. 

(B)  Is  paying  all  of  his  or  her  net  non-exempt  income  in  excess  of  the 
SSI/SSP  payment  level  toward  the  cost  of  IHSS. 

(2)  The  person: 

(A)  Was  once  determined  to  be  disabled  in  accordance  with  Section 
1614,  Part  A,  Title  XVI,  Social  Security  Act. 

(B)  Was  eligible  for  SSI/SSP  but  became  ineligible  because  of  engage- 
ment in  substantial  gainful  activity  as  defined  in  Title  XVI  regulations. 

(C)  Continues  to  suffer  from  the  physical  or  mental  impairments 
which  were  the  basis  of  the  disability  determination. 

(D)  Has  been  determined  by  the  county  social  services  staff  to  require 
assistance  in  one  or  more  of  the  areas  specified  under  the  definition  of 
severely  impaired  in  the  social  services  regulations  of  the  Department  of 
Social  Services. 

(E)  Is  paying  all  of  his  or  her  net  non-exempt  income  in  excess  of  the 
SSI/SSP  payment  level  toward  the  cost  of  IHSS. 

(b)  The  provisions  of  this  regulation  shall  also  apply  to  eligibility  de- 
terminations or  redeterminations  made  retroactively  to  January  1,  1979. 
NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Insfitutions 
Code.  Reference:  Sections  12305,  12305.5,  Welfare  and  Institutions  Code. 

History 

1.  Amendment  filed  8-7-78;  effecfive  thirtieth  day  thereafter  (Register  78,  No. 

32). 

2.  Amendment  filed  10-31-78  as  an  emergency;  designated  effective  11-1-78 
(Register  78,  No.  44). 

3.  Certificate  of  Compliance  filed  2-6-79  (Register  79,  No.  6). 

4.  Amendment  filed  5-17-79  as  an  emergency;  effective  upon  filing  (Register  79, 
No.  20). 

5.  Certificate  of  Compliance  filed  9-12-79  (Register  79,  No.  37). 

§  50247.    Twenty  Percent  Social  Security  Increase. 

(a)  The  Twenty  Percent  Social  Security  Increase  category  includes 
persons  or  families  who  were  all  of  the  following: 

(1)  Eligible  for  or  receiving  a  cash  grant  in  August  J  972. 

(2)  Entitled  to  monthly  Social  Security  benefits  in  August  1972. 

(3)  Discontinued  from  cash  grant  eligibility  solely  because  of  the  20 
percent  increase  in  Social  Security  benefits  under  PuWic  Law  92-336. 

(b)  Persons  or  families  considered  to  have  been  ehgible  for  or  receiv- 
ing a  cash  grant  in  August  1972  are  those  persons  who  were: 

(1)  Receiving  a  cash  grant. 

(2)  Not  receiving  a  cash  grant  due  to  adjustment  for  overpayment. 

(3)  Not  receiving  a  cash  grant  because  it  had  been  suspended  in  order 
to  determine  the  amount  of  the  grant. 

(4)  Not  receiving  an  AFDC  cash  grant  because  their  income  was  less 
than  the  MBSAC  but  greater  than  the  payment  standard. 

(5)  Eligible  for  a  cash  grant  but  refused  it. 

(c)  Persons  or  families  considered  to  have  been  entitled  to  Social  Secu- 
rity benefits  in  August  1972,  ar  those  persons  who  either: 

(1)  Received  Social  Security  benefits  in  August  1972. 

(2)  Subsequently  received  Social  Security  benefits  which  included  ret- 
roactive payment  for  August  1972. 

(d)  Eligibility  under  this  category  shall  be  determined  as  follows: 

(1)  Establish  that  the  conditions  in  (a)  are  met. 

(2)  Determine,  on  the  Computation  of  SSP  Payment  for  Adult  Aid  Re- 
cipients, SSP  1 ,  or  the  AFDC  Budget  Worksheet,  CA  241 ,  the  net  income 
in  accordance  with  SSI/SSP  or  AFDC  regulations,  whichever  is  appro- 
priate. 


(3)  Subtract  the  amount  of  the  20  percent  Social  Security  increase  re- 
ceived in  October  1972  from  the  net  income. 

(4)  If  the  amount  determined  in  (3)  is  less  than  the  MBSAC  or  the  SSI/ 
SSP  payment  level,  whichever  is  appropriate,  the  person  is  eligible  under 
this  category. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.1  and  14050.1,  Welfare  and  Institutions  Code. 

History 

1.  Amendment  of  subsection  (d)(2)  filed  8-7-78;  effective  thirtieth  day  thereafter 
(Register  78,  No.  32). 

2.  Amendment  of  subsection  (d)  filed  7-31-81  as  an  emergency;  effective  upon 
filing.  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  1 20  days 
or  emergency  language  will  be  repealed  on  1 1-28-81. 

3.  Certificate  of  Compliance  transmitted  to  OAL  11-6-81  and  filed  1-27-82 
(Register  82,  No.  5). 

§  50249.     Medically  Needy  Program. 

NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14005.3,  Welfare  and  Institutions  Code. 

History 

1.  Amendment  of  subsection  (a)  filed  12-15-77;  effecfive  thirtieth  day  thereafter 
(Register  77,  No.  51). 

2.  Amendment  of  subsection  (a)(  1  )(A)  and  (a)(2)(B)  filed  8-7-78;  effective  thir- 
tieth day  thereafter  (Register  78,  No.  32). 

3.  Repealer  filed  3-7-80  as  an  emergency;  effective  upon  filing  (Register  80,  No. 
9).  A  Certificate  of  Comphance  must  be  transmitted  to  OAH  within  120  days 
or  emergency  language  will  be  repealed  on  7-6-80. 

4.  Certificate  of  Compliance  filed  6-6-80  (Register  80,  No.  23). 

§  50251 .     Medically  Indigent  Program. 

(a)  A  person  under  2 1  years  of  age  shall  have  eligibihty  determined  un- 
der the  Medically  Indigent  program  if  that  person  is  any  of  the  following: 

(1)  A  person  who  cannot  meet  the  eligibility  requirements  as  a  PA  or 
Other  PA  recipient,  an  MN  person,  or  an  MN  family  member. 

(2)  A  person  who  is  not  an  MN  family  member  because  of  the  exclu- 
sion of  a  child  from  theMFBU. 

(3)  A  child  who  is  not  living  with  a  parent  or  relative  and  for  whom  a 
public  agency  is  assuming  financial  responsibility  in  whole  or  in  part. 

(4)  A  child  receiving  assistance  under  Aid  tor  Adoption  of  Children. 

(5)  A  child  who  is  not  eligible  as  an  AFDC  MN  person  because  the 
child  is  not  living  with  a  relative. 

(6)  A  person  under  21  years  of  age  who  can  qualify  as  an  MN  blind  or 
disabled  person  but  chooses  to  apply  as  an  MI  person.  The  choice  may 
be  made  by  a  person  acting  on  behalf  of  the  person  under  21  years  of  age. 

(b)  A  person  age  21  years  or  older  shall  have  eligibility  determined  un- 
der the  Medically  Indigent  program  if  that  person  is  all  of  the  following: 

(1)  Underage  65. 

(2)  Unable  to  meet  the  eligibility  requirements  as  PA  or  Other  PA  re- 
cipient, an  MN  person,  or  an  MN  family  member. 

(3)  Either  pregnant  or  residing  in  a  skilled  nursing  or  an  intermediate 
care  facility. 

(c)  In  order  to  be  eligible  under  this  program,  the  persons  listed  in 
(a)(1),  (2),  (5),  (6)  and  (b)  shall  meet  the  property,  ciuzenship,  residence, 
insritutional  status  and  cooperation  requirements  specified  in  these  regu- 
lations. 

(d)  In  order  to  be  certified  and  receive  a  Medi-Cal  card  under  this  pro- 
gram the  persons  Usted  in  (a)(1),  (2),  (5),  (6)  and  (b)  shall  be  determined 
eligible  and  meet  the  income  and  share  of  cost  requirements  specified  in 
these  regulafions. 

(e)  Children  specified  in  (a)(3)  shall  be  ehgible  and  certified  for  Medi- 
Cal: 

(1)  On  the  basis  of  the  information  provided  by  the  public  agency  on 
form  MC  250. 

(2)  Without  considering  the  property  or  income  of  the  child  or  the 
child's  parents. 

(f)  The  children  specified  in  (a)(4)  above  shall  be  eligible  and  certified 
for  Medi-Cal  without  any  additional  determinations  by  the  county  de- 
partment. 

(g)  For  purposes  of  tliis  section: 


Page  340.1 


Register  96,  Nos  8-9;  3-1-96 


§  50253 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


(1)  Persons  are  considered  21  years  of  age  on  the  first  day  of  the  month 
following  the  month  in  which  they  reach  age  21. 

(2)  Persons  are  considered  1 8  years  of  age  on  the  first  day  of  the  month 
in  which  they  reach  age  18. 

NOTE:  Authority  cited:  Sections  10723  and  14124.5,  Welfare  and  Institutions 
Code:  Section  57(c).  AB  799,  Chapter  328,  Statutes  of  1982;  and  Section  87(c), 
SB  20 12,  Chapter  1594,  Statutes  of  1982.  Reference:  Sections  1 4005.4  and  14052, 
Welfare  and  Institutions  Code. 

History 

1.  Amendment  of  subsections  (a)(2),  (a)(3).  (a)(5).  and  adoption  of  subsection  (0 
filed  8-7-78;  effective  thirtieth  day  thereafter  (Register  78,  No.  32). 

2.  Amendment  filed  2-5-80  as  an  emergency;  effective  upon  filing  (Register  80, 
No.  6).  A  Certificate  of  Compliance  must  be  transmitted  to  OAH  within  120 
days  or  emergency  language  will  be  repealed  on  6-5-80. 

3.  Certificate  ofCompliance  transmitted  to  OAH  6^-80  and  filed  6-6-80  (Reeis- 
ter  80,  No.  23). 

4.  Amendment  of  subsection  (a)(4)  filed  8-8-80;  effecfive  thirtieth  day  thereafter 
(Register  80,  No.  32). 

5.  Amendment  filed  l-8-81;effective  thirtieth  day  thereafter  (Register81,No.2). 

6.  Amendment  of  subsections  (a)-(c)  filed  3-24-82;  effective  thirtieth  day  there- 
after (Register  82,  No.  1 3). 

7.  Amendment  filed  12-31-82  as  an  emergency;  effective  upon  filing  (Register 
83,  No.  2).  A  Certificate  ofCompliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  4-30-83. 

8.  Certificate  of  Compliance  transmitted  to  OAL  4-13-83  and  filed  5-16-83 
(Register83,  No.  21). 

§  50253.    Miscellaneous  Special  Programs. 

Miscellaneous  Special  Programs  are  those  specified  in  Sections  50255 
through  50263. 

NOTE;  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14142  and  14145,  Welfare  and  Insfitutions  Code. 

History 
1.  Amendment  filed  7-19-82;  effective  thirtieth  day  thereafter  (Register  82,  No. 
30). 

§  50255.     Repatriate  Program. 

Persons  eligible  for  cash  payments  and  other  assistance  under  the  Re- 
patriate program  shall  not  be  eligible  for  Medi-Cal.  Medi-Cal  eligibility 
may  be  established  upon  discontinuance  from  the  program. 

§  50256.    Qualified  Disabled  and  Working  Individual 
Program. 

(a)  Eligibility  Criteria:  To  receive  Medi-Cal  benefits  under  the  Quali- 
fied Disabled  and  Working  Individual  Program  an  eligible  individual 
must: 

(1 )  Be  entitled  to  enroll  in  Part  A  Medicare  hospital  insurance  benefits 
for  the  disabled  and  working,  and 

(2)  Not  have  net  nonexempt  income  that  exceeds  200  percent  of  the 
federal  poverty  level  as  defined  by  Section  50041.5.  The  qualifying  in- 
come level  as  defined  in  Section  50571  (the  share  of  cost  process  for  in- 
curred medical  expenses  under  Article  12  of  this  chapter)  is  not  applica- 
ble under  this  program,  and 

(3)  Not  have  property  that  exceeds  twice  the  resource  limit  as  defined 
by  Section  50421.5. 

(b)  Period  of  Eligibility:  Eligibility  for  the  Qualified  Disabled  and 
Working  Individual  Program  shall  be  in  accordance  with  Sections 
50701,  50703  and  50710. 

(c)  Benefits:  The  Department  shall  pay  Medicare  Part  A  hospital  pre- 
miums for  qualified  disabled  and  working  individuals  as  defined  in  Sec- 
tion 50079.6. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Insfitutions 
Code;  and  Section  12,  Chapter  1430.  Statutes  of  1989.  Reference:  Section 
14005.3,  Welfare  and  Insfitutions  Code;  and  Sections  1396a(a)(10)(E)  and 
1396d(s),  Title  42,  United  States  Code. 

History 

1.  New  section  filed  10-3-94  as  an  emergency;  operative  10-3-94  (Register  94, 
No.  40).  A  Certificate  ofCompliance  must  be  transmitted  to  OAL  by  1-31-95 
or  emergency  language  will  be  repealed  by  operation  of  law  on  the  following 
day. 

2.  Editorial  correction  of  History  Note  1  (Register  95,  No.  9). 

3.  Repealed  by  operation  of  Government  Code  section  11346.1(g)  (Register  95, 
No.  9). 


4.  New  section  refiled  3-3-95  as  an  emergency;  operative  3-3-95  (Register  95, 
No.  9).  A  Certificate  ofCompliance  must  be  transmitted  to  OAL  by  7-1-95  or 
emergency  language  will  be  repealed  by  operation  of  law  on  the  following  day. 

5.  Certificate  ofCompliance  as  to  3-3-95  order  including  amendment  of  section 
and  NOTi^  transmitted  to  OAL  2-22-95  and  filed  4-5-95  (Register  95,  No.  14). 


§  50257.    Refugee  Medical  Assistance  (RMA)  and  Entrant 
Medical  Assistance  (EMA). 

(a)  Refugees  and  entrants  who  are  not  otherwise  eligible  for  Medi-Cal 
under  federally-funded  AFDC,  SSI/SSP,  MN  or  Medically  Indigent 
Child  programs  may  be  eligible  for  Medi-Cal  through  the  special  federal 
programs  of  Refugee  Medical  Assistance  (RMA)  or  Entrant  Medical  As- 
sistance (EMA). 

(b)  Refugees  and  entrants  who  apply  for  Medi-Cal  under  the  RMA  or 
EMA  programs  shall: 

(1)  Meet  the  definition  contained  in  the  Department  of  Social  Services 
(DSS)  Manual  of  Policy  and  Procedures  (MPP)  of  "refugee"  (MPP  sec- 
tions 69.203.1  and  69.203.2),  "children  of  refugees"  (MPP  section 
69-203.3),  or  "entrant"  (MPP  sections  69-301  through  69-305). 

(2)  Have  their  eligibility  for  Medi-Cal  under  the  RMA  or  EMA  pro- 
grams detennined  in  accordance  with  articles  4  through  1 3  (commencing 
with  section  50141)  of  this  chapter;  however,  in-kind  services  and/or 
shelter  provided  to  refugees  by  a  sponsor  or  resettlement  agency  are  not 
to  be  considered  as  income. 

(3)  Provide  the  name  of  the  resettlement  agency  to  the  county  welfare 
department. 

(c)  Recipients  of  Refugee  Cash  Assistance  (RCA)  or  Entrant  Cash  As- 
sistance (ECA)  shall  automatically  receive  a  Medi-Cal  card.  But  receipt 
of  RCA/ECA  is  not  a  condition  of  RMA/EMA  eligibility.  Refugees  may 
apply  for  "RMA/FMA-Only"  benefits. 

(d)  Recipients  of  RCA/ECA  who  become  ineligible  for  these  cash  pro- 
grams solely  because  of  increased  earnings  from  employment  will  con- 
tinue to  be  eligible  for  up  to  eight  months  of  transitional  RMA/EMA 
benefits  with  no  share-of-cost.  Eligibility  for  RMA/EMA  is  limited  until 
the  end  of  the  RMA/EMA  time-eligibility  period  specified  in  subsection 
(e)  of  this  Section. 

(e)  Eligibility  for  Medi-Cal  under  the  RMA  or  EMA  programs  shall 
be  limited  to  the  shorter  of  the  following  periods: 

(1)  The  refugee's  first  eight  months  of  United  States  residency,  begin- 
ning with  the  month  of  entry,  or  the  entrant's  (including  entrant  children 
bom  in  the  United  States  resettlement  camps)  first  eight  months  of  parole 
(release  from  Immigration  and  Naturalization  Service  custody). 

(2)  The  time  period  for  which  DHS  determines  that  sufficient  federal 
funds  are  available  under  the  Refugee  Resettlement  Program  (RRP)  and 
Cuban  and  Haitian  Entrant  Program  (CHEP). 

(f)  Refugees  shall  be  ineligible  for  RMA/EMA  if: 

(1)  They  have  been  denied  or  terminated  from  RCA/ECA  for  failure 
or  refusal  to  comply  with  registration,  employment,  education  or  training 
requirements  of  MPP  section  69-208;  or 

(2)  They  are  full-time  students  in  an  institution  of  higher  education, 
as  defined  by  MPP  section  69-206.51,  except  where  such  enrollment  is 
part  of  an  employability  plan  developed  by  a  county  welfare  department 
or  its  designee  per  MPP  sections  69-206.52,  69-206.53,  or  69-206.54, 
or  is  part  of  a  plan  for  an  unaccompanied  minor  meeting  the  requirements 
of  sections  69-213.23  or  69-213.62. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  Section  57,  Chapter  328,  Statutes  of  1982;  and  Section  87,  Chapter  1594, 
Statutes  of  1982.  Reference:  Sections  14005.4  and  14011.5,  Welfare  and  Institu- 
tions Code;  and  Sections  400.90  through  400.156;  400.200  through  400.212,  and 
400.300  through  400.319,  Title  45,  Code  of  Federal  Regulations. 

History 

1.  Repealer  and  new  section  filed  12-31-82  as  an  emergency;  effective  upon  filing 
(Register  83,  No.  2).  A  Certificate  ofCompliance  must  be  transmitted  to  OAL 
within  120  days  or  emergency  language  will  be  repealed  on  4-30-83. 

2.  Certificate  of  Compliance  including  editorial  correction  of  subsection(b)(l) 
transnutted  to  OAL  4-13-83  and  filed  5-16-83  (Register  83,  No.  21). 

3.  Amendment  of  subsections  (b)(1)  and  (d)(1)  filed  8-7-90;  operative  9-6-90 
(Register  90,  No.  39). 


Page  340.2 


Register  96,  Nos  8-9;  3-1-96 


Title  22 


Health  Care  Services 


§  50258 


4.  Amendment  of  section  and  Note  filed  2-28-96;  operative  3-29-96  (Register 
96,  No.  9). 

§  50258.    Qualified  Medicare  Beneficiary  Program. 

(a)  Eligibility  Criteria:  To  receive  Medi-Cal  benefits  under  the  Quali- 
fied Medicare  Beneficiary  program  an  individual  eligible  for  such  bene- 
fits must: 

(1)  Be  entitled  to  Part  A  Medicare  hospital  insurance  benefits,  and 

(2)  Meet  the  qualifying  income  level  as  defined  in  section  50570  (the 
share  of  cost  process  for  incurred  medical  expenses  under  article  12  of 
this  chapter  is  not  applicable  under  tliis  program),  and 

(3)  Meet  the  qualifying  property  (resource)  limit  as  defined  in  section 
50421. 


(b)  Period  of  Eligibility:  Notwithstanding  sections  50701,  50703  and 
50710,  eligibility  for  the  Qualified  Medicare  Beneficiary  Program  shall 
begin  the  first  of  the  month  following  the  month  of  approval. 

(c)  Benefits:  The  Department  shall  pay:  Medicare  premiums, 
coinsurance,  and  deductibles  for  qualified  Medicare  beneficiaries  as  de- 
fined in  section  50079.7. 

NOTE:  Authority  cited:  Sections  10725,  14005.1 1  and  14124.5,  Welfare  and  Insti- 
tutions Code;  and  Section  1 2,  Chapter  1 430,  Statutes  of  1 989.  Reference:  Sections 
1396a(a)  and  1 396d(p),  Title  42,  United  States  Code;  and  Section  1 4005. 1 1 ,  Wel- 
fare and  Institutions  Code. 

History 

1.  New  section  filed  8-13-90  as  an  emergency;  operative  8-13-90  (Register  90, 
No.  40).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  12-1 1-90 


[The  next  page  is  340.3.] 


• 


Page  340.2(a) 


Register  96,  Nos  8-9;  3-1-96 


Title  22 


Health  Care  Services 


§  50262 


or  emergency  language  will  be  repealed  by  operation  of  law  on  the  following 
day. 

2.  Certificate  of  Compliance  transmitted  to  OAL  12-1 J-90  and  filed  1-9-91 
(Register  91,  No.  8). 

3.  Amendment  of  subsection  (c)  filed  10-3-94  as  an  emergency;  operative 
10-3-94(Register94,  No.  40).  A  Certificate  of  Compliance  must  be  transmitted 
to  OAL  by  1-31-95  oremergency  language  will  be  repealed  by  operation  of  law 
on  the  following  day. 

4.  Editorial  cortection  of  History  Note  3  (Register  95,  No.  9). 

5.  Reinstatement  of  subsection  (c)  as  it  existed  prior  to  emergency  amendment 
filed  3-2-95  by  operation  of  Government  Code  section  1 1 346.1  (f)  (Register  95, 
No.  9). 

6.  Amendment  of  subsection  (c)  refiled  3-3-95  as  an  emergency;  operative 
3-3-95  (Register  95,  No.  9).  A  Certificate  of  Compliance  must  be  transmitted 
to  OAL  by  7-1-95  oremergency  language  will  be  repealed  by  operation  of  law 
on  the  following  day. 

7.  Certificate  of  Compliance  as  to  3-3-95  order  transmitted  to  OAL  2-22-95  and 
filed  4-5-95  (Register  95,  No.  14). 

§  50258.1.    Specified  Low-Income  Medicare  Beneficiary 
Program  (SLIVIB). 

(a)  Eligibility  Criteria:  A  SLMB  is  ineligible  as  a  QMB  solely  due  to 
excess  income.  To  receive  Medi-Cal  benefits  under  the  SLMB  program 
an  individual  eligible  for  such  benefits  must: 

(1)  Be  entitled  to  Part  A  Medicare  hospital  insurance  benefits,  and 

(2)  Meet  the  qualifying  income  level  as  defined  in  Section  50570(b) 
(the  share  of  cost  process  for  incurred  medical  expenses  under  Article  1 2 
of  this  chapter  is  not  applicable  under  this  program),  and 

(3)  Meet  the  qualifying  property  (resource)  limit  as  defined  in  Section 
50421. 

(b)  Period  of  Eligibility:  Eligibility  for  the  SLMB  program  shall  begin 
the  first  month  eligibility  is  approved.  A  SLMB  may  be  eligible  for  up 
to  three  months  of  retroactive  benefits  from  the  month  of  application  as 
provided  in  Section  50710  but  no  earlier  than  January  1,  1993. 

(c)  Benefits:  The  Department  shall  pay  Medicare  Part  B  premiums  for 
SLMB  as  defined  in  Section  50091.5. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  1396a(a)(10)(E)(iii),  Title  42,  United  States  Code. 

History 
1.  New  section  filed  12-21-93;  operative  1-20-94  (Register  93,  No.  52). 

§  50259.    Indochinese  Refugee  Status. 

NOTE;  Authority  cited:  Sections  10554.1  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14005,  Welfare  and  Institutions  Code. 

History 

1 .  Amendment  filed  7-20-78  as  an  emergency;  effective  upon  filing  (Register  78, 
No.  29). 

2.  Certificate  of  Compliance  transmitted  to  OAH  11-16-78  and  filed  1 1-17-78 
(Register  78,  No.  46). 

3.  Repealer  filed  12-31-82  as  an  emergency;  effective  upon  filing  (Register  83, 
No.  2).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  4-30-83. 

4.  Certificate  of  Compliance  transmitted  to  OAL  4-13-83  and  filed  5-16-83 
(Register  83,  No.  21). 

§  50260.     60-Day  Postpartum  Services  Program. 

A  pregnant  woman  who  was  eligible  for  and  received  Medi-Cal  dur- 
ing the  last  month  of  pregnancy,  shall  continue  to  be  eligible  for  all  preg- 
nancy related  and  postpartum  services,  for  a  60-day  period  beginning  on 
the  last  day  of  pregnancy,  regardless  of  whether  the  other  conditions  of 
eligibility  are  met.  Eligibility  for  this  program  ends  on  the  last  day  of  the 
month  in  which  the  60th  day  occurs. 

NOTE:  Authority  cited:  Sections  14105  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.3  and  14100.1,  Welfare  and  Institutions  Code; 
and  42  United  States  Code  Section  1396a  (e)  (5). 

History 

1.  New  section  filed  1-4-88  as  an  emergency;  operative  1^-88  (Register  88,  No. 
3).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days  or 
emergency  language  will  be  repealed  on  5-4-88. 

2.  Certificate  of  Compliance  transmitted  to  OAL  4-28-88  and  filed  5-31-88 
(Register  88,  No.  23). 


§  50261.    Special  Medi-Cal  Dialysis  Programs. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14140,  14141,  14142,  14143  and  14145,  Welfare  and 
Institutions  Code. 

History 

1 .  Amendment  filed  5-1 6-80  as  an  emergency;  effective  upon  filing  (Register  80, 
No.  20).  A  Certificate  of  Compliance  must  be  transmitted  to  OAH  within  120 
days  or  emergency  language  will  be  repealed  on  9-14-80. 

2.  Certificate  of  Compliance  filed  8-22-80  (Register  80,  No.  34). 

3.  Repealer  filed  3-25-81  as  an  emergency;  effective  upon  filing  (Register  81 ,  No. 
13).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  7-23-81  (Register  81,  No.  13). 

4.  Reinstatement  of  section  as  it  existed  prior  to  emergency  repealer  filed  3-25-81 
by  operation  of  Govemment  Code  Section  1 1346.1(f)  (Register  82,  No.  30). 

5.  Repealer  filed  7-19-82;  effective  thirtieth  day  thereafter  (Register  82,  No.  30). 


§  50262.     Special  Zero  Share  of  Cost  Programs  for 
Pregnant  Women  and  Infants. 

The  following  eligibility  criteria  shall  apply  to  pregnant  women,  and 
infants  under  one  year  old  with  a  share  of  cost.  As  used  in  this  section  the 
terms  "woman"  and  "women"  mean  any  female  regardless  of  age.  Coun- 
ties shall  determine  eligibility  for  applicants  and  beneficiaries  under  ei- 
ther of  the  programs  described  in  subsections  (a)(1)  and  (a)(2).  Eligibility 
shall  first  be  determined  under  subsection  (a)(1). 

(a)  Eligibility  criteria: 

(1 )  185  Percent  Program.  The  net  nonexempt  Medi-Cal  Family  Bud- 
get Unit  (MFBU)  income  of  an  otherwise  eligible  pregnant  woman,  or 
infant  under  one  year  old,  shall  be  above  the  maintenance  income  need 
level  but  shall  not  exceed  185  percent  of  the  federal  poverty  level,  as  re- 
vised annually  in  accordance  with  section  673(2)  of  the  Omnibus  Budget 
Reconciliation  Act  of  1981  (Public  Law  97-35). 

(2)  200  Percent  Program.  The  net  nonexempt  Medi-Cal  Family  Bud- 
get Unit  (MFBU)  income  of  an  otherwise  eligible  pregnant  woman,  or 
infant  under  one  year  old,  shall  exceed  1 85  percent  of  the  federal  poverty 
level  as  specified  in  (a)(l )  but  shall  not  exceed  200  percent  of  the  federal 
poverty  level,  as  revised  annually  in  accordance  with  section  673(2)  of 
the  Omnibus  Budget  Reconciliation  Act  of  1981  (Public  Law  97-35). 

(3)  In  determining  net  nonexempt  income  of  the  MFBU,  all  deductions 
and  exemptions  applicable  solely  to  AFDC-MN  persons  or  families,  as 
provided  in  article  10,  shall  be  allowed  except  health  insurance  pre- 
miums. 

(4)  A  pregnant  woman  or  infant  may  not  reduce  MFBU  income  to  the 
185  or  200  percent  level  by  meeting  a  share  of  cost. 

(5)  If  the  pregnant  woman  and/or  infant  meet  the  requirements  of  the 
200  Percent  Program,  but  have  assets  which  exceed  the  resource  Umit, 
the  assets  shall  be  waived  for  those  applicants  or  beneficiaries  in  accor- 
dance with  Section  50401(b). 

(b)  Period  of  EUgibility: 

(1)  Pregnant  woman.  Eligibility  for  the  pregnant  woman  shall  begin 
no  earlier  than  the  first  day  of  the  month  for  which  pregnancy  is  verified. 
Eligibility  shall  end  on  the  last  day  of  the  month  of  the  60-day  period  im- 
mediately following  the  last  day  of  pregnancy. 

(2)  Infant.  Eligibility  for  an  infant  shall  end  upon  attainment  of  age 
one,  unless  the  infant  is  an  inpatient  for  whom  medical  services  are  pro- 
vided during  a  continuous  period  which  began  before  his/her  first  birth- 
day. In  that  event,  the  infant  shall  continue  to  be  eligible  until  the  end  of 
the  stay  for  which  the  inpatient  services  are  furnished. 

(3)  Retroactive  eligibility.  Eligibility  for  a  pregnant  woman  or  infant 
may  be  established  retroactively  in  any  of  the  three  months  immediately 
preceding  the  month  of  application  as  provided  in  section  50710. 

(c)  Scope  of  Benefits: 

(1)  A  pregnant  woman  shall  be  eligible  only  for  pregnancy  related  ser- 
vices, including  services  for  conditions  which  complicate  pregnancy. 

(2)  An  otherwise  eligible  infant  shall  receive  full  Medi-Cal  benefits 
if  the  infant  is  a  United  States  citizen  or  meets  the  requirements  of  section 
14007.5  of  the  Welfare  and  Institutions  Code,  as  added  by  Statutes  of 
1988,  chapter  1441,  Section  3.  If  the  infant  does  not  meet  the  require- 


Page  340.3 


Register  98,  No.  47;  11-20-98 


§  50262.3 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


menls  of  this  subsection,  services  shall  be  restricted  to  treatment  of  emer- 
gency medical  conditions  only. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  ln.slitutions 
Code.  Reference:  Sectioas  14007.5, 14148,  14148.1  and  14148.5,  Welfare  and  In- 
stitutions Code. 

History 

1 .  New  section  tiled  6-27-89  as  an  emergency;  operative  6-27-89  (Register  89, 
No.  26).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  10-25-89. 

2.  Certificate  of  Compliance  as  to  6-27-89  order  including  change  without  regula- 
tory effect  of  subsection  (c)(2)  transmitted  to  OAL  10-25-89  and  filed 
1 1-22-89  (Register  89,  No.  48). 

3.  Amendment  of  subsections  (a)  and  (b)  filed  1-23-90  as  an  emergency;  opera- 
tive 1-23-90  (Register  90,  No.  4).  A  Certificate  of  Compliance  must  be  trans- 
mitted to  OAL  within  120  days  or  emergency  language  will  be  repealed  by  oper- 
ation of  law  on  5-23-90. 

4.  Certificate  of  Compliance  as  to  1-23-90  order  including  amendment  trans- 
mitted to  OAL  5-22-90  and  filed  6-21-90  (Register  90,  No.  33). 

5.  Editorial  correction  of  subsection  (c)  printing  enor  (Register  90,  No.  33). 

6.  New  subsection  (a)(5)  filed  5-28-92  as  an  emergency;  operative  5-28-92  (Reg- 
ister 92,  No.  22).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL 
9-25-92  or  emergency  language  will  be  repealed  by  operation  of  law  on  the  fol- 
lowing day. 

7.  Certificate  of  Compliance  as  to  5-28-92  order  transmitted  to  OAL  9-25-92  and 
filed  10-19-92  (Register  92,  No.  43). 

§  50262.3.     Continued  Eligibility  Program  for 

Pregnant/Postpartum  Women  and  Infants. 

(a)  A  pregnant  woman  who  has  applied  for,  been  determined  eligible 
for  and  is  receiving  Medi-Cal,  shall  continue  to  remain  eligible  for  preg- 
nancy-related services  throughout  the  pregnancy  and  the  60-day  post- 
partum period  beginning  on  the  last  day  of  pregnancy,  regardless  of  any 
increases  in  her  family's  income. 

(b)  Infants  bom  to  women  who  are  eligible  for  and  receiving  Medi-Cal 
at  the  time  of  birth  are  automatically  deemed  eligible  for  one  year  without 
a  separate  Medi-Cal  apphcation  and  social  security  identification  num- 
ber. In  addition,  these  infants  shall  remain  eligible,  regardless  of  any  in- 
creases in  the  family's  income,  as  long  as  the  following  conditions  con- 
tinue to  apply: 

(1)  the  infant  continues  to  hve  with  his/her  mother;  and 

(2)  the  mother  remains  eligible  for  Medi-Cal  or  would  have  remained 
eligible  if  she  were  still  pregnant. 

(c)  Individuals  described  in  (a)  or  (b)  above  must  continue  to  meet  all 
other  eligibility  criteria. 

NOTE:  Authority  cited:  Sections  10725, 14016.1 0  and  14124.5,  Welfare  and  Insti- 
turions  Code.  Reference:  Title  42,  Sections  1396a(e)(4),  1396a(e)(5)  and 
1396a(e)(6)  of  the  United  States  Code. 

History 

1.  New  section  filed  4-27-94  as  an  emergency;  operative  4-27-94  (Register  94, 
No.  17).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  8-25-94 
or  emergency  language  will  be  repealed  by  operation  of  law  on  the  following 
day. 

2.  Certificate  of  Compliance  as  to  4-27-94  order  transmitted  to  OAL  8-24-94  and 
filed  9-29-94  (Register  94,  No.  39). 

3.  Editorial  correction  of  subsection  (c)  (Register  94,  No.  39). 

4.  Editorial  correction  of  Authority  cite  (Register  95,  No.  43). 


provided  in  article  10,  shall  be  allowed  except  health  insurance  pre- 
miums. 

(3)  A  child  may  not  reduce  MFBU  income  to  the  1 33  percent  level  by 
meeting  a  share  of  cost. 

(4)  When  determining  eligibility  for  the  133  Percent  Program,  proper- 
ty shall  be  disregarded  in  accordance  with  Section  50401(c). 

(b)  Period  of  Eligibility: 

(1)  Tlie  period  of  eligibility  for  the  133  Percent  program  shall  begin 
no  earlier  than  the  first  day  of  the  month  of  the  child' s  first  birthday  unless 
the  child  is  an  inpatient  for  whom  medical  services  are  provided  during 
a  continuous  period  which  began  before  his/her  first  birthday  and  he/she 
remains  eligible  under  the  1 85  or  200  percent  program.  Once  the  continu- 
ous inpatient  stay  ends,  the  child  must  be  evaluated  for  the  1 33  Percent 
program  if  he/she  has  not  attained  age  six. 

(2)  The  period  of  eligibility  for  the  133  Percent  program  shall  end  on 
the  last  day  of  the  month  in  which  the  child  attains  age  six  unless  the  child 
is  an  inpatient  for  whom  medical  services  are  provided  during  a  continu- 
ous period  which  began  before  his/lier  sixth  birthday.  In  that  event,  the 
period  of  eligibility  continues  under  the  133  Percent  program  until  the 
end  of  the  stay  for  which  the  inpatient  services  are  furnished  so  long  as 
the  child  would  have  remained  ehgible  under  the  133  Percent  program 
but  for  attaining  the  age  of  six. 

(c)  Scope  of  Benefits: 

(1)  An  otherwise  eligible  child  shall  receive  full  Medi-Cal  benefits  if 
the  child  is  a  United  States  citizen  or  meets  the  requirements  of  section 
50302.  If  the  child  does  not  meet  the  requirements  of  tliis  section,  ser- 
vices shall  be  restricted  to  treatment  of  emergency  medical  conditions 
only. 

(2)  Services  provided  under  this  section  shall  not  be  subject  to  any 
share  of  cost  requirements. 

NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.1, 14007.5,  14050.1  and  14148.75,  Welfare  and 
Institutions  Code;  and  Title  42,  Sections  1395(a)(3)(E),  1396a(a)(10)(A)(i)(VI), 
(e)(7),  (/)  and  1396b(v),  United  States  Code. 

History 

1 .  New  section  filed  10-01-90  as  an  emergency;  operative  1 0-1  -90  (Register  90, 
No.  45).  A  Certificate  of  Compliance  must  be  transmitted  by  OAL  by  1-29-91 
or  emergency  language  will  be  repealed  by  operation  of  law  on  the  following 
day. 

2.  Certificate  of  Compliance  including  amendment  of  subsections  (a)  and  (c)  trans- 
mitted to  OAL  1-28-91  and  filed  2-19-91  (Register  91,  No.  12). 

3.  Amendment  of  subsection  (a),  new  subsection  (a)(4),  and  amendment  of  Note 
filed  4-2-98  as  an  emergency;  operative  4-2-98.  Submitted  to  OAL  for  print- 
ing only  pursuant  to  Welfare  and  Institutions  Code  section  14148.75  (Register 
98,  No.  16).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by 
9-29-98  or  emergency  language  will  be  repealed  by  operation  of  law  on  the  fol- 
lowing day. 

4.  Amendment  of  subsection  (a),  new  subsection  (a)(4),  and  amendment  of  Note 
refiled  4-15-98  as  an  emergency,  including  additional  amendment  of  subsec- 
tion (a)(4);  operative  4-15-98.  Submitted  to  OAL  for  printing  only  pursuant  to 
WelfareandlnstitutionsCodesectionl4]48.75(Register98,No.  16).  A  Certifi- 
cate of  Compliance  must  be  transmitted  to  OAL  by  1 0-12-98  or  emergency  lan- 
guage will  be  repealed  by  operation  of  law  on  the  following  day. 

5.  Editorial  correction  of  History  3  and  History  4  (Register  98,  No.  47). 

6.  Certificate  of  Compliance  as  to  4-15-98  order  transmitted  to  OAL  1 0-9-98  and 
filed  11-18-98  (Register  98,  No.  47). 


§  50262.5.    Special  Zero  Share  of  Cost  Program  for 
Children  of  Age  One  Up  to  Age  Six  (133 
Percent  Program). 

(a)  Children  who  have  attained  one  year  of  age  but  have  not  attained 
six  years  of  age  are  eligible  to  receive  Medi-Cal  benefits  under  the  133 
Percent  program  if  the  following  conditions  are  satisfied: 

(1)  The  net  nonexempt  Medi-Cal  Family  Budget  Unit  (MFBU)  in- 
come of  otherwise  eligible  children  shall  not  exceed  133  percent  of  the 
federal  income  official  poverty  line  as  defined  by  the  Office  of  Manage- 
ment and  Budget,  and  revised  annually  in  accordance  with  section  673(2) 
of  the  Omnibus  Budget  Reconciliation  Act  of  1981  (Public  Law  97-35). 

(2)  In  determining  net  nonexempt  income  of  the  MFBU,  all  deductions 
and  exemptions  applicable  solely  to  AFDC-MN  persons  or  families,  as 


§  50262.6.    Special  Zero  Share  of  Cost  Program  for 

Children  of  Age  Six  Up  to  Age  Nineteen  (100 
Percent  Program). 

(a)  Children  who  have  attained  six  years  of  age  but  have  not  attained 
nineteen  years  of  age  are  eligible  to  receive  Medi-Cal  benefits  under  the 
100  Percent  program  if  the  following  conditions  are  satisfied: 

(1)  The  net  nonexempt  Medi-Cal  Family  Budget  Unit  (MFBU)  in- 
come of  otherwise  eligible  children  shall  not  exceed  100  percent  of  the 
federal  poverty  level  as  defined  in  Section  50041.5. 

(2)  In  determining  net  nonexempt  income  of  the  MFBU,  all  deductions 
and  exemptions  applicable  solely  to  AFDC-MN  persons  or  families,  as 
provided  in  Article  10  of  this  chapter,  shall  be  allowed  except  health  in- 
surance premiums. 


Page  340.4 


Register  98,  No.  47;  11-20-98 


Title  22 


Health  Care  Services 


§  50264 


• 


(3)  A  child  may  not  reduce  MFBU  income  to  the  100  percent  level  by 
meeting  a  share  of  cost. 

(4)  When  determining  eligibility  for  the  1 00  Percent  Program,  proper- 
ty shall  be  disregarded  in  accordance  with  Section  50401(c). 

(5)  Notwithstanding  Section  50014,  children  are  defined  for  this  pro- 
gram as  persons  under  19  years  of  age. 

(b)  Period  of  Eligibility: 

(1)  The  period  of  eligibility  for  the  100  Percent  program  shall  begin 
no  earlier  than  the  first  day  of  the  month  of  the  child's  sixth  birthday  un- 
less the  child  is  an  inpatient  for  whom  medical  services  are  provided  dur- 
ing a  continuous  period  that  began  before  his/her  sixth  birthday  and  he/ 
she  remains  eligible  under  Sections  50262  or  50262.5.  Once  the 
continuous  inpatient  stay  ends,  the  child  must  be  evaluated  for  the  100 
Percent  program  if  he/she  has  not  attained  age  nineteen. 

(2)  The  period  of  eligibility  for  the  100  Percent  program  shall  end  on 
the  last  day  of  the  month  in  which  the  child  attains  age  nineteen  unless 
the  child  is  an  inpatient  for  whom  medical  services  are  provided  during 
a  continuous  period  that  began  before  his/her  sixth  birthday.  In  that 
event,  the  period  of  eligibility  continues  under  the  100  Percent  program 
until  the  end  of  the  stay  for  which  the  inpatient  services  are  furnished  so 
long  as  the  child  would  have  remained  eligible  under  the  100  Percent  pro- 
gram but  for  attaining  the  age  of  nineteen. 

(c)  Scope  of  Benefits: 

(1)  An  otherwise  eligible  child  shall  receive  full  Medi-Cal  benefits  if 
the  child  is  a  United  States  citizen  or  meets  the  requirements  of  Section 
50301.  If  the  child  does  not  meet  the  requirements  of  this  section,  ser- 
vices shall  be  restricted  to  treatment  of  emergency  medical  conditions 
and  pregnancy  related  services  only. 

(2)  Services  provided  under  this  section  shall  not  be  subject  to  any 
share  of  cost  requirements. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.1,  14005.23,  14007.5,  14050.1  and  14148.75, 
Welfare  and  Institutions  Code;  and  Title  42,  Sections  1395(a)(3)(E), 
1396a(a)(10)(A)(i)(VII),  (e)(7),  (/),  1396b(v)  and  1396(/)(1)(D),  United  States 
Code. 

History 

1 .  New  section  filed  10-26-95  as  an  emergency;  operative  10-26-95  (Register95, 
No.  43).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  2-23-96 
or  emergency  language  will  be  repealed  by  operation  of  law  on  the  following 
day. 

2.  Certificate  of  Compliance,  as  to  10-26-95  order  including  editorial  correction 
of  subsection  (b)(2),  transmitted  to  OAL  2-21-96  and  filed  3-20-96  (Register 
96,  No.  12). 

3.  Amendment  of  subsection  (a),  new  subsections  (a)(4)  and  (a)(5),  and  amend- 
ment of  subsection  (b)(1)  and  Note  filed  4-2-98  as  an  emergency;  operative 
4-2-98.  Submitted  to  OAL  for  printing  only  pursuant  to  Welfare  and  Institu- 
tions Code  section  14148.75  (Register  98,  No.  16).  A  Certificate  of  Compliance 
must  be  transmitted  to  OAL  by  9-29-98  or  emergency  language  will  be  re- 
pealed by  operation  of  law  on  the  following  day. 

4.  Amendment  of  subsection  (a),  new  subsections  (a)(4)  and  (a)(5),  and  amend- 
ment of  subsections  (b)(1)  and  Note  refiled  4-15-98  as  an  emergency,  includ- 
ing additional  amendment  of  subsection  (a)(4);  operative  4-15-98.  Submitted 
to  OAL  for  printing  only  pursuant  to  Welfare  and  Institutions  Code  section 
14148.75  (Register  98,  No.  16).  A  Certificate  of  Compliance  must  be  trans- 
mitted to  OAL  by  10-12-98  or  emergency  language  will  be  repealed  by  opera- 
tion of  law  on  the  following  day. 

5.  Editorial  correction  of  History  3  and  History  4  (Register  98,  No.  47). 

6.  Certificate  of  Compliance  as  to  4-1 5-98  order  transmitted  to  OAL  10-9-98  and 
filed  11-18-98  (Register  98,  No.  47). 

§  50262.7.    Targeted  Case  Management  Services  Program. 

NOTE:  Authority  cited:  Sections  10725,  14105,  14124.5  and  14132.44,  Welfare 
and  Institutions  Code.  Reference:  Section  14132.44,  Welfare  and  Institutions 
Code. 

History 
1.  New  section  filed  7-1-96;  operative  7-1-96.  Submitted  to  OAL  for  printing 
only  pursuant  to  Section  6,  Chapter  305,  Statutes  of  1995  (Register  96,  No.  27). 


2.  New  section  refiled  10-29-96  as  an  emergency;  operative  10-29-96  (Register 
96,  No.  44).  Submiued  to  OAL  for  printing  only  pursuant  to  Section  6,  Chapter 
305,  Statutes  of  1995.  A  Certificate  of  Compliance  must  be  transmitted  to  OAL 
by  2-26-97  or  emergency  language  will  be  repealed  by  operation  of  law  on  the 
following  day. 

3.  Editorial  correction  of  History  2  (Register  97.  No.  15). 

4.  Repealed  bv  operation  of  Government  Code  section  1 1346.1(g)  (Register  97, 
No.  15). 

5.  New  section  filed  4-10-97;  operative  4-10-97  pursuant  to  Government  Code 
section  11343.4(d)  (Register  97,  No.  15). 

6.  Change  without  regulatory  effect  renumbering  former  section  50262.7  to  new 
section  51365  filed  6-9-97  pursuant  to  section  100,  title  I.  California  Code  of 
Regulations  (Register  97,  No.  24). 

§  50263.    MC  800  Program. 

(a)  The  MC  800  program  is  an  eligibility  process  that  a  county  depart- 
ment may  choose  to  urihze  to  determine  eligibility  for  persons  receiving 
health  care  services  at  either  a  county  medical  facility  or  a  county  con- 
tract hospital.  This  process  shall  not  be  utilized  unless  the  county  depart- 
ment executes  a  waiver  agreeing  to  abide  by  payment  adjustments  made 
pursuant  to  post-audits  conducted  by  the  Department,  in  accordance 
with  procedures  established  by  the  Director. 

(b)  If  the  county  department  chooses  to  utilize  the  MC  800  program, 
persons  who  meet  the  requirements  set  forth  in  (c)  shall  be  allowed  to  se- 
lect one  of  the  following  methods  of  having  their  eligibility  determined: 

(1)  The  Medi-Cal  application  process,  as  specified  in  Article  4. 

(2)  The  MC  800  process,  in  accordance  with  Department  procedures. 

(c)  Persons  who  may  have  their  eligibility  determined  in  accordance 
with  the  MC  800  program  are  those  who  meet  the  requirements  of  the  MI 
program  and  are  all  of  the  following: 

(1)  At  least  21  years  of  age. 

(2)  Not  eligible  under  any  PA,  Other  PA,  MN  or  special  program. 

(3)  Not  currently  certified  as  a  Medi-Cal  beneficiary. 

(4)  Not  applying  for  coverage  for  any  health  care  services  received 
prior  to  admission  to  or  receipt  of  services  at  the  county  medical  facility 
or  county  contract  hospital. 

(5)  Not  being  transferred  to  a  long-term  care  or  private  medical  facil- 
ity. 

(6)  Not  eligible  under  another  pubhc  program  that  must  bill  Medi-Cal 
for  health  care  services  provided  to  that  program's  beneficiaries. 

History 
1.  Amendment  of  subsection  (a)  filed  8-7-78;  effecuve  thirtieth  day  thereafter 
(Register  78,  No.  26). 

§  50264.    Medi-Cal  Special  Treatment  Programs. 

(a)  Medi-Cal  Special  Treatment  Programs  consist  of: 

(1)  The  Medi-Cal  Special  Treatment  Programs — Only: 

(A)  The  Medi-Cal  Dialysis  Only  program  which  covers  persons  who 
are  eligible  under  provisions  of  Arricle  17,  only  for  dialysis  and  related 
services. 

(B)  The  Medi-Cal  Parenteral  Hyperalimentation  Only  program  which 
covers  persons  who  are  eligible  under  provisions  of  Article  17,  only  for 
parenteral  hyperalimentation  and  related  services. 

(2)  The  Medi-Cal  Special  Treatment  Programs — Supplement: 

(A)  The  Medi-Cal  Dialysis  Supplement  program  which  covers  per- 
sons eligible  under  the  Medically  Needy  or  the  Medically  Indigent  pro- 
grams and  who  also  meet  the  applicable  eligibility  requirements  con- 
tained in  Article  17. 

(B)  The  Medi-Cal  Parenteral  Hyperalimentation  Supplement  pro- 
gram which  covers  persons  who  are  eligible  under  the  Medically  Needy 
or  Medically  Indigent  programs  and  who  also  meet  the  applicable  eligi- 
bility requirements  contained  in  Article  17. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5.  Welfare  and  Institutions 
Code.  Reference:  Secfions  14140, 14141, 14142, 14143,  14144  and  14145,  Wel- 
fare and  Insntutions  Code. 


[The  next  page  is  341.] 

Page  340.5 


Register  98,  No.  47;  11-20-98 


Title  22 


Health  Care  Services 


§  50273 


• 


History 

1.  New  section  filed  3-25-81  as  an  emergency;  effective  upon  filing  (Register  8J, 
No.  13).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  7-23-8 1 . 

2.  Order  of  Repeal  of  3-25-81  emergency  order  filed  4-3-81  by  OAL  pursuant 
to  Government  Code  Section  11349.6  (Register  81,  No.  14). 

3.  New  section  filed  7-19-82;  effecfive  thirtieth  day  thereafter  (Register  82,  No. 
30). 

§  50265.     Medi-Cal  Aid  Codes. 

(a)  Aid  codes  shall  be  used  in  the  classification  and  reporting  of  Medi- 
Cal  beneficiaries  as  required  by  the  Department's  written  procedures. 

History 
1.  Amendment  filed  8-7-78;  effective  thirtieth  day  thereafter  (Register  78,  No. 

32). 

§  50268.    Tuberculosis  (TB)  Program. 

(a)  Eligibility  Criteria:  To  be  eligible  under  the  Tuberculosis  (TB)  Pro- 
gram an  individual  shall: 

(1)  Be  diagnosed  by  a  Medi-Cal  provider  as  infected  with  TB  as  de- 
fined in  Section  51187. 

(2)  Have  net  nonexempt  income  as  determined  pursuant  to  Article  10 
which  does  not  exceed  the  maximum  amount  for  a  disabled  individual  as 
provided  in  42  United  States  Code  Section  1396a(a)(lO)(A)(i). 

(3)  Have  net  nonexempt  resources  as  determined  pursuant  to  Article 
9  which  do  not  exceed  the  maximum  amount  for  property  reserve  for  a 
disabled  individual  as  under  42  United  States  Code  Section 
1396a(a)(10)(A)(i).  These  amounts  are  specified  in  Section  50420. 

(4)  Meet  the  citizenship,  immigration  status,  and  documentation  re- 
quirements for  full  Medi-Cal  benefits  as  specified  in  Article  7. 

(b)  Period  of  Eligibility:  Eligibility  for  the  TB  Program  shall  begin  the 
first  month  eligibility  is  approved.  A  person  with  TB  may  be  eligible  for 
retroactive  benefits  in  any  of  the  three  months  immediately  preceding  the 
month  of  application  as  provided  in  Section  50710,  but  not  earher  than 
October  1,  1994. 

(c)  Benefits:  TB  infected  individuals  under  this  program  shall  be  eligi- 
ble only  for  TB  related  services  as  defined  in  Section  51355. 

(d)  Individuals  eligible  under  this  program  shall  have  no  share  of  cost. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Secfions  14059  and  14132,  Welfare  and  Institutions  Code. 

History 

1.  New  section  filed  8-16-95  as  an  emergency;  operative  8-16-95  (Register  95, 
No.  33).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  12-14-95 
or  emergency  language  will  be  repealed  by  operafion  of  law  on  the  following 
day. 

2.  New  section  refiled  12-14-95  as  an  emergency;  operative  12-14-95  (Register 
95,  No.  50).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by 
4-12-96  or  emergency  language  will  be  repealed  by  operation  of  law  on  the  fol- 
lowing day. 

3.  New  section  refiled  4-8-96  as  an  emergency;  operative  4-8-96  (Register  96, 
No.  15).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  8-6-96 
or  emergency  language  will  be  repealed  by  operation  of  law  on  the  following 
day. 

4.  Certificate  of  Compliance  as  to  4-8-96  order,  including  amendment  of  subsec- 
tion (a)(3),  transmitted  to  OAL  7-30-96  and  filed  9-11-96  (Register  96,  No. 
37). 

Article  6.     Institutional  Status 

§  50271 .     Institutional  Status— General. 

The  status  of  being  an  inmate  in  public  or  private  institutions  shall  be 
a  factor  in  the  determination  of  Medi-Cal  eligibility  as  specified  in  Sec- 
tion 50273.  The  eligibility  of  inmates  whose  institutional  status  does  not 
cause  ineligibility  under  Section  50273  shall  be  contingent  upon  all  other 
eligibility  requirements  being  met. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  11014,  11016  and  14053,  Welfare  and  Institutions 
Code. 

History 
1 .  Repealer  and  new  section  filed  4-2-83;  effective  thirtieth  day  thereafter  (Regis- 
ter 83,  No.  14). 


§  50273.    Medi-Cal  Ineligibility  Due  to  Institutional  Status. 

(a)  Individuals  who  are  inmates  of  public  institutions  are  not  eligible 
for  Medi-Cal:  The  following  individuals  are  considered  inmates  of  a 
public  institution: 

(1 )  An  individual  in  a  prison,  or  a  county,  city,  or  tribal  jail. 

(2)  An  individual  in  a  prison  or  jail:  Prior  to  arraignment,  prior  to  con- 
viction, or  prior  to  sentencing. 

(3)  An  individual  who  is  incarcerated,  but  can  leave  prison  or  jail  on 
work  release  or  work  furlough  and  must  return  at  specific  intervals. 

(4)  Individuals  released  from  prison  or  jail  due  to  a  medical  emergency 
who  would  otherwise  by  incarcerated  but  for  the  medical  emergency.  In- 
stitutional status  of  such  persons  is  not  affected  by  transfer  to  a  public  or 
private  medical  facility. 

(5)  A  minor  in  a  juvenile  detention  center  prior  to  disposition  (judge- 
ment) due  to  criminal  activity  of  the  minor. 

(6)  A  minor,  after  disposition,  placed  in  a  detention  or  correctional  fa- 
cility, including  a  youth  ranch,  forestry  camp,  or  home  which  is  part  of 
the  criminal  justice  system. 

(7)  A  minor  placed  on  probation  by  a  juvenile  court  on  juvenile  inten- 
sive probation  with  specific  conditions  of  release,  including  residence  in 
a  juvenile  detention  center. 

(8)  A  minor  placed  on  probation  by  a  juvenile  court  on  juvenile  inten- 
sive probation  to  a  secure  treatment  facility  contracted  with  the  juvenile 
detention  center  if  the  secure  treatment  facility  is  part  of  the  criminal  jus- 
tice system. 

(9)  Individuals  between  the  ages  of  21-65  who  are  in  an  institution  for 
mental  diseases  shall  be  considered  inmates  of  a  public  institution  until 
they  are  unconditionally  released. 

(b)  Ineligibility  for  individuals  classified  as  inmates  in  (a)  begins  on 
the  day  institutional  status  commences  and  ends  on  the  day  institutional 
status  ends. 

(c)  The  following  individuals  are  not  considered  inmates  of  a  public 
institution  and  shall  be  eligible  for  Medi-Cal  provided  that  all  other  re- 
quirements for  eligibility  set  out  in  this  chapter  are  satisfied: 

(1)  An  individual  released  from  prison  or  jail  on  permanent  release, 
bail,  own  recognizance  (OR),  probation,  or  parole  with  a  condition  of: 

(A)  Home  arrest; 

(B)  Work  release; 

(C)  Community  service; 

(D)  Outpatient  treatment; 

(E)  Inpatient  treatment. 

(2)  An  individual  who,  after  arrest  but  before  booking,  is  escorted  by 
police  to  a  hospital  for  medical  treatment  and  held  under  guard. 

(3)  An  individual  in  prison  or  jail  who  transfers  temporarily  to  a  half- 
way house  or  residential  treatment  facility  prior  to  a  formal  probation  re- 
lease order. 

(4)  An  individual  released  from  prison  or  jail  under  a  court  probation 
order  due  to  a  medical  emergency. 

(5)  A  minor  in  a  juvenile  detention  center  prior  to  disposition  (judg- 
ment) due  to  care,  protection  or  in  the  best  interest  of  the  child  (e.g..  Child 
Protective  Services)  if  there  is  a  specific  plan  for  that  person  that  makes 
the  stay  at  the  detention  center  temporary.  This  would  include  those  juve- 
niles awaiting  placement  but  still  physically  present  in  juvenile  hall. 

(6)  A  minor  placed  on  probation  by  a  juvenile  court  on  juvenile  inten- 
sive probation  with  home  arrest  restrictions. 

(7)  A  minor  placed  on  probation  by  a  juvenile  court  on  juvenile  inten- 
sive probation  to  a  secure  treatment  facility  contracted  with  the  juvenile 
detention  center  if  the  secure  treatment  facility  is  not  part  of  the  criminal 
justice  system. 

(8)  A  minor  placed  on  probation  by  a  juvenile  court  on  juvenile  inten- 
sive probation  with  treatment  as  a  condition  of  probation: 

(A)  In  a  psychiatric  hospital; 

(B)  In  a  residential  treatment  center; 

(C)  As  an  outpatient. 


Page  341 


Register  96,  No.  37;  9-13-% 


§  50275 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


(9)  Individuals  released  from  an  institution  for  mental  diseases  or 
transferred  from  such  an  institution  to  a  public  or  private  medical  facility. 

(10)  Individuals  on  conditional  release  or  convalescent  leave  from  an 
institution  for  mental  diseases. 

(11)  Individuals  under  age  22  who  are  patients  in  an  institution  for 
mental  diseases,  were  institutionalized  prior  to  their  21st  birthday,  and 
continue  to  receive  inpatient  psychiatric  care. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  11014,  11016  and  14053,  Welfare  and  Institutions 
Code;  Sections  401 1 .1  and  401 5,  Penal  Code;  42  U .S.C.  Section  1396d(a)(24)(A); 
and  42  CFR  Sections  435. 1 008  and  435. 1 009. 

History 

1.  Repealer  and  new  section  filed  4-1-83  effective  thirtieth  day  thereafter  (Regis- 
ter 83,  No.  14).  For  prior  history,  see  Register  77,  No.  51. 

2.  Amendment  filed  4-10-86;  effective  thirtieth  day  thereafter  (Register  86,  No. 
15). 

3.  Amendment  of  subsections  (c)  and  (d)  filed  4-1 7-89;  operative  5-17-89  (Reg- 
ister 89,  No.  48.) 

4.  Repealer  and  new  section  filed  1-26-95;  operative  2-27-95  (Register  95,  No. 
4). 

§  50275.    Voluntary  Inmates. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institufions 
Code.  Reference:  Sections  11014,  11016  and  14053,  Welfare  and  Institutions 
Code. 

History 
] .  Repealer  filed  4-1-83;  effective  thirtieth  day  thereafter  (Register  83,  No.  14). 

§  50279.    Limitations  of  Institutional  Status. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  11014,  11016  and  14053,  Welfare  and  Institutions 
Code. 

History 
1 .  Repealer  filed  4-1-83;  effecfive  thirtieth  day  thereafter  (Register  83,  No.  14). 

Article  7.    Alienage,  Citizenship  and 
Residence 

§  50301 .    Citizenship  or  Immigration  Status  for  Full 
Medi-Cal  Benefits. 

(a)  "Full  Medi-Cal  benefits"  means  all  the  services  ordinarily  covered 
by  the  Medi-Cal  program. 

(b)  To  be  eligible  for  full  Medi-Cal  benefits,  an  applicant  or  beneficia- 
ry shall  be  a  California  resident  who  is  one  of  the  following: 

(1)  A  citizen  of  the  United  States. 

(2)  A  national  of  the  United  States  from  American  Samoa  or  Swain's 
Island. 

(3)  An  alien  who  has  been  lawfully  admitted  to  the  United  Stales  for 
permanent  residence.  This  category  includes  "conditional  permanent 
resident"  who  have  been  granted  a  two-year  period  lawful  admission  for 
of  permanent  residence  in  accordance  with  section  216  of  the  Immigra- 
tion and  Nationality  Act  (8  USC  1186a). 

(4)  An  alien  permanently  residing  in  the  United  States  under  color  of 
law.  (PRUCOL). 

(5)  An  amnesty  alien  (lawful  temporary  resident  or  lawful  permanent 
resident)  whose  status  has  been  adjusted  in  accordance  with  section  210, 
210A  or  245A  of  the  Immigration  and  Nationality  Act  (8  USC  sections 
1160,  1 161  or  1255a)  if  the  alien  meets  one  of  the  following  conditions: 

(A)  The  alien  is  aged,  blind,  disabled,  or  under  18  years  of  age,  or 

(B)  More  than  five  years  has  elapsed  since  the  date  the  alien  was 
granted  lawful  temporary  resident  stahis.  The  date  of  granting  is  the  date 
the  alien  filed  his  or  her  application  for  lawful  temporary  resident  status. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  and  Section  9,  Chapter  1441,  Statutes  of  1988.  Reference:  Section  14007.5, 
Welfare  and  Insfitutions  Code. 

History 
1.  Amendment  filed  10-20-88  as  an  emergency;  operative  10-20-88  (Register 
88,  No.  45).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  1 20 
days  or  emergency  language  will  be  repealed  on  2-20-89. 


2.  Amendment  refiled  2-10-89  as  an  emergency;  operadve  2-15-89  (Register  89, 
No.  8).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  6-15-89. 

3.  Amendment  refiled  6-5-89  as  an  emergency;  operative  6-15-89  (Register  89. 
No.  23).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  10-13-89. 

4.  Certificate  of  Compliance  transmitted  to  OAL  10-12-89  and  disapproved  by 
OAL  on  1 1-13-89  (Register  89,  No.  48). 

5.  Repealer  and  new  section  tiled  1 1-14-89  as  an  emergency  pursuant  to  section 
9  of  chapter  1 441  of  the  Statutes  of  1 988;  operative  1 1-14-89  (Register  89,  No. 
48).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  3-14—90. 

6.  Repealer  and  new  section  refiled  3-8-90  as  an  emergency  pursuant  to  section 
9  of  chapter  1441  of  the  Statutes  of  1988;  operative  3-13-90  (Register  90,  No. 
12).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  7-1 1-90. 

7.  Certificate  of  Compliance  as  to  3-8-90  order  transmitted  to  OAL  7-5-90  and 
disapproved  8-6-90  (Register  90,  No.  42). 

8.  Repealer  and  new  secfion  filed  8-23-90  as  an  emergency  pursuant  to  section 
9  of  chapter  1 441  of  the  Statutes  of  1 988;  operative  8-23-90  (Register  90,  No. 
42).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  12-21-90  or 
emergency  language  will  be  repealed  by  operation  of  law  on  the  following  day. 

9.  Certificate  of  Compliance  including  amendment  as  to  8-23-90  order  trans- 
mitted to  OAL  11-20-90  and  filed  12-17-90  (Register  91,  No.  5). 

§  50301 .1 .     Documentation  of  Status  as  a  Citizen  or 
National  of  the  United  States. 

(a)  Applicants  in  this  classification  shall  present  a  document  which  es- 
tablishes their  identify,  such  as  a  driver's  license,  and  an  original  docu- 
ment which  serves  as  evidence  that  an  applicant  is  a  citizen  or  national 
of  the  United  States. 

(1)  If  the  applicant  declares  a  birthplace  outside  of  the  United  States 
or  its  outlying  possessions,  or 

(2)  If  evidence  exists  which  suggests  that  the  applicant  may  be  falsely 
claiming  to  be  a  citizen  or  national  of  the  United  States. 

(b)  Documents  which  establish  status  as  a  citizen  or  national  of  the 
U.S.  include  the  following: 

(1)  A  birth  certificate  issued  by  a  governmental  entity  within  the 
United  States  or  its  outlying  possessions. 

(2)  A  United  States  passport. 

(3)  United  States  Citizen  Identification  Card  (INS  Form  1-197)  or 
Identification  Card  for  Use  of  Resident  Citizen  in  the  United  States 
(1-179). 

(4)  Certificate  of  Naturalization  (INS  Form  N-550  or  N-570). 

(5)  Certificate  of  Citizenship  (INS  Form  N-560  or  N-561). 

(6)  Certification  of  Birth  Abroad  (Dept.  of  State  Form  FS-545  or 
DS-1350). 

(7)  Report  of  Birth:  Child  Bom  Abroad  of  American  Parent  or  Parents 
(Dept.  of  State  Form  FS-240). 

(8)  Northern  Mariana  Identification  Card  issued  by  INS  to  persons 
bom  in  the  Northern  Mariana  Islands  who  are  now  U.S.  citizens. 

(9)  A  religious  document,  of  which  the  issuing  organization  has  a  re- 
cord, showing  that  the  birth  took  place  in  the  U.S.  Rehgious  documents 
shall  be  accepted  only  in  the  absence  of  other  types  of  evidence. 

(10)  An  Individual  Fee  Register  Receipt  (INS  Form  G-711)  which 
shows  that  the  person  has  filed  an  Application  for  a  New  Naturalization 
or  Citizenship  Paper  (INS  Form  N-565). 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  and  Section  9,  Chapter  1441,  Statutes  of  1988.  Reference:  Sections  14011 
and  14007.5,  Welfare  and  Institufions  Code. 

History 

1.  New  section  filed  11-14-89  as  an  emergency  pursuant  to  section  9  of  chapter 
1441  of  the  Statutes  of  1988;operauve  11-14-89  (Register  89,  No.  48).  A  Cer- 
tificate of  Compliance  must  be  transmitted  to  OAL  within  120  days  or  emergen- 
cy language  will  be  repealed  on  3-14-90. 

2.  New  section  refiled  3-8-90  as  an  emergency  pursuant  to  section  9  of  chapter 
1441  of  the  Statutes  of  1988;  operative  3-1 3-90  (Register  90,  No.  12).  A  Certifi- 
cate of  Compliance  must  be  transmitted  to  OAL  within  120  days  or  emergency 
language  will  be  repealed  on  7-11-90. 

3.  Certificate  of  Compliance  as  to  3-8-90  order  transmitted  to  OAL  7-5-90  and 
disapproved  8-6-90  (Register  90,  No.  42). 

4.  Repealer  and  new  section  filed  8-23-90  as  an  emergency  pursuant  to  section 
9  of  chapter  1441  of  the  Statutes  of  1988;  operafive  8-23-90  (Register  90,  No. 
42).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  12-21-90  or 
emergency  language  will  be  repealed  by  operation  of  law  on  the  following  day. 


Page  342 


Register  96,  No.  37;  9-13-96 


Title  22  Health  Care  Services  §  50301.2 

5.  Certificate  of  Compliance  including  amendment  as  to  8-23-90  order  trans-  driver's  license,  which  establishes  their  identity  and  one  or  more  of  the 

mitted  to  OAL  1 1-20-90  and  filed  12-1 7-90  (Register  91 ,  No.  5).  following  documents- 

§  50301 .2.     Documentation  of  Status  as  an  Alien  Lawfully  (a)  ^n  Alien  Registration  Receipt  Card  (INS  Form  1-551  or  earlier 

Admitted  for  Permanent  Residence.  Forms  1-151  of  AR-3a). 

Applicants  in  this  classification  shall  present  a  document,  such  as  a 


• 


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• 


Page  342.1  Register  96,  No.  37;  9-13-96 


Title  22 


Health  Care  Services 


§  50301.3 


• 


(b)  An  Arrival-Departure  Record  (INS  Form  1-94)  or  foreign  passport 
with  a  special  stamp  showing  that  an  Alien  Registration  Receipt  Card 
(INS  Form  1-551)  will  be  issued. 

(c)  An  INS  Form  1-18 lb  notification  letter  issued  in  connection  with 
an  INS  Form  1-181,  Memorandum  of  Creation  of  Record  of  Lawful  Per- 
manent Residence,  which  shows  that  an  Alien  Registration  Receipt  Card 
(INS  Form  1-551)  will  be  issued. 

(d)  A  Permit  to  Re-enter  the  United  States  (INS  Form  1-327). 

(e)  A  letter  from  the  Canadian  Department  of  Indian  Affairs,  a  birth  or 
baptismal  record  issued  on  a  Canadian  Indian  reservation  or  tribal  or 
school  records  which  establish  that  an  American  Indian  bom  in  Canada 
is  of  at  least  one  half  American  Indian  ancestry. 

(f)  An  Individual  Fee  Register  Receipt  (INS  Form  G-71 1 )  for  replace- 
ment of  a  lost  stolen  or  unreadable  alien  registration  or  alien  admission 
document  listed  in  this  section. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  and  Section  9,  Chapter  1441,  Statutes  of  1988.  Reference:  Sections  14011 
and  14007.5,  Welfare  and  Institutions  Code. 

History 

1.  New  section  filed  11-14-89  as  an  emergency  pursuant  to  section  9  of  chapter 
1441  of  the  Statutes  of  1988;  operative  1 1-14-89  (Register  89,  No.  48).  A  Cer- 
tificate of  Compliance  must  be  transmitted  to  OAL  within  1 20  days  or  emergen- 
cy language  will  be  repealed  on  3-14-90. 

2.  New  section  refiled  3-8-90  as  an  emergency  pursuant  to  section  9  of  chapter 
1441  of  the  Statutes  of  1988;  operative  3-13-90(Register  90,  No.  12).  A  Certifi- 
cate of  Compliance  must  be  transmitted  to  OAL  within  1 20  days  or  emergency 
language  will  be  repealed  on  7-11-90. 

3.  Certificate  of  Compliance  as  to  3-8-90  order  transmitted  to  OAL  7-5-90  and 
disapproved  8-6-90  (Register  90,  No.  42). 

4.  Repealer  and  new  section  filed  8-23-90  as  an  emergency  pursuant  to  section 
9  of  chapter  1441  of  the  Statutes  of  1988;  operative  8-23-90  (Register  90,  No. 
42).  A  Certificate  of  CompUance  must  be  transmitted  to  OAL  by  12-21-90  or 
emergency  language  will  be  repealed  by  operation  of  law  on  the  following  day. 

5.  Certificate  of  Compliance  as  to  8-23-90  order  transmitted  to  OAL  1 1-20-90 
and  filed  12-17-90  (Register  91,  No.  5). 

§  50301 .3.     Documentation  of  Status  as  an  Alien 

Permanently  Residing  in  the  United  States 
Under  Color  of  Law  (PRUCOL). 

Applicants  in  this  classification  shall  present  a  document  which  esta- 
blishes their  identity,  such  as  a  driver's  license,  and  one  or  more  of  the 
following  INS-issued  documents: 

(a)  Aliens  admitted  to  the  United  States  before  April  1, 1980  in  accor- 
dance with  Immigration  and  Nationality  Act  (INA)  section  203(a)(7)  (8 
use  1 153(a)(7)):  Arrival-Deparmre  Record,  INS  Form  1-94.  annotated 
'REFUGEE-CONDITIONAL  ENTRY." 

(b)  Aliens  paroled  into  the  United  States  for  an  indefinite  period  in- 
cluding Cuban/Haitian  Entrants  and  Publiclnterest/Humanitarian  Parol- 
ees: INS  Form  1-94,  with  notation  that  the  alien  has  been  paroled  into  the 
United  States  pursuant  to  INA  section  212(d)(5)  (8  USC  1182(d)(5))  or 
stamped  "Cuban/Haitian  Entrant  (Status  Pending)  reviewable  January 
15,  1981.  Employment  authorized  until  January  15,  1981". 

(c)  Aliens  subject  to  an  Order  of  Supervision:  INS  Form  1-220B. 

(d)  Aliens  granted  an  indefinite  stay  of  deportation:  INS  Form  1-94  or 
a  letter  from  INS  showing  this  status. 

(e)  AHens  granted  an  indefinite  voluntary  departure:  INS  Form  1-94 
or  a  letter  from  INS  showing  this  status. 

(f)  Aliens  on  whose  behalf  an  INS  Form  1-130  (Petition  to  Classify 
Status  of  Alien  Relative  for  Issuance  of  Immigrant  Visa)  has  been  filed, 
with  their  families  covered  by  the  petition,  who  are  entitled  to  voluntary 
departure  but  whose  departure  INS  does  not  contemplate  enforcing:  INS 
Form  1-94  showing  this  status  or  Alien  Voluntary  Departure  Notice,  INS 
Form  1-210. 

(g)  Aliens  who  have  filed  applications  for  adjustment  to  lawfully  ad- 
mitted for  permanent  residence  status  that  INS  has  accepted  as  "properly 
filed":  an  INS  Form  1-181  Memorandum  of  Creation  of  Record  of  Law- 
ful Permanent  Residence,  an  INS  For  1-94  (Arrival-Departure  Record) 
stamped  I&NA  section  245  Applicant,  or  a  properly  endorsed  U.S.  pass- 
port. 


(h)  Aliens  granted  a  stay  of  deportation  for  a  specific  period  by  court 
order,  statute  or  regulation,  or  by  individual  determination  of  INS  in  ac- 
cordance with  INA  section  1 06  (8  USC  1 105a)  or  relevant  INS  Operating 
Instruction  and  whose  departure  INS  does  not  contemplate  enforcing: 
INS  Form  1-94,  a  letter  from  INS,  or  an  order  issued  by  a  District  Director 
of  INS,  the  Executive  Office  of  Immigration  Review,  or  a  federal  court. 

(i)  Aliens  granted  asylum  in  accordance  with  INA  secfion  208  (8  USC 
1 1 58):  INS  Form  1-94  and  a  letter  from  INS  showing  this  status. 

(j)  Aliens  admitted  as  refugees  since  April  1 ,  1980:  Arrival-Departure 
Record,  INS  Form  1-94,  amiotated:  "ADMITTED  AS  A  REFUGEE 
PURSUANT  TO  SECTION  207  OF  THE  IMMIGRATION  AND  NA- 
TIONALITY ACT"  or  an  unexpired  Refugee  Travel  Document,  INS 
Form  1-571. 

(k)  Aliens  granted  voluntary  departure,  whose  departure  INS  does  not 
contemplate  enforcing:  INS  Form  1-94  showing  this  status  or  Alien  Vol- 
untary Departure  Notice,  INS  Form  1-210  bearing  a  departure  date. 

(/)  Aliens  in  deferred  action  status  pursuant  to  INS  operating  instruc- 
tions: Alien  Voluntary  Departure  Notice,  INS  Form  1-210  or  a  letter  from 
INS  showing  this  status. 

(m)  Aliens  who  have  applied  for  an  adjustment  of  status  from  undocu- 
mented alien  to  alien  lawfully  admitted  for  permanent  residence  in  accor- 
dance with  INA  section  249  (8  USC  1259)  on  the  basis  of  having  entered 
and  continuously  resided  in  the  United  States  since  before  January  1 , 
1972:  Individual  Fee  Register  Receipt,  INS  Form  G-711  and  an  Inter- 
view Appointment  Letter,  INS  Form  1^68. 

(n)  Aliens  who  have  been  granted  suspension  of  deportation  in  accor- 
dance with  INA  section  244  (8  USC  1254)  whose  departure  INS  does  not 
contemplate  enforcing:  Arrival-Departure  Record,  INS  Form  1-94  and 
an  order  issued  by  the  Executive  Office  of  Immigration  Review. 

(o)  Aliens  who  deportation  is  being  withheld  in  accordance  with  INA 
section  243(h)  (8  USC  1253(h)):  Arrival-Departure  Record,  INS  Form 
1-94  and  an  order  issued  by  the  Executive  Office  of  Immigration  Review. 

(p)  Citizens  of  the  Republic  of  the  Marshall  Islands  or  the  Federated 
States  of  Micronesia  who,  in  accordance  with  48  USC  sections  1681 
through  1695,  may  live,  work  or  study  in  the  United  States  without  re- 
strictions: Arrival-Departure  Record,  INS  Form  1-94  annotated  "CFA/ 
MIS"  or  "CFA/FSM." 

(q)  Aliens  granted  extended  voluntary  departure  for  a  specified  time 
due  to  conditions  in  their  home  countries:  Arrival-Departure  Record, 
INS  Form  1-94  showing  this  status  or  Ahen  Voluntary  Departure  Nofice, 
INS  Form  1-210. 

(r)  Aliens  whose  INS  documents  have  been  lost  or  stolen  or  are  unread- 
able: An  Individual  Fee  Register  Receipt  (INS  Form  G-711)  which 
shows  the  person  has  applied  for  replacement  of  a  lost,  stolen  or  unread- 
able alien  registration  or  alien  admission  document  listed  in  this  section. 

(s)  Aliens  living  in  the  United  States  with  the  knowledge  and  permis- 
sion of  INS  whose  departure  that  agency  does  not  contemplate  enforcing: 
INS  documents  which  establish  these  facts. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  and  Section  9,  Chapter  1441,  Statutes  of  1 988.  Reference:  Sections  14007.5 
and  14011,  Welfare  and  Institutions  Code. 

History 

1.  New  section  filed  1 1-14-89  as  an  emergency  pursuant  to  section  9  of  chapter 
1441  of  the  Statutes  of  1988;  operative  1 1-14-89  (Register  89,  No.  48).  A  Cer- 
tificate of  Compliance  must  be  transmitted  to  OAL  within  1 20  days  or  emergen- 
cy language  will  be  repealed  on  3-14-90. 

2.  New  .secfion  refiled  3-8-90  as  an  emergency  pursuant  to  section  9  of  chapter 
1441  of  the  Statutesof  1988;  operative  3-13-90  (Register  90,  No.  12).  ACertifi- 
cate  of  Compliance  must  be  transmitted  to  OAL  within  1 20  days  or  emergency 
language  will  be  repealed  on  7-11-90. 

3.  Certificate  of  Compliance  as  to  3-8-90  order  transmitted  to  OAL  7-5-90  and 
disapproved  8-6-90  (Register  90,  No.  42). 

4.  Repealer  and  new  section  filed  8-23-90  as  an  emergency  pursuant  to  section 
9  of  chapter  1441  of  the  Statutes  of  1988;  operative  8-23-90  (Register  90,  No. 
42).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  12-21-90  or 
emergency  language  will  be  repealed  by  operation  of  law  on  the  following  day. 

5.  Certificate  of  Compliance  including  amendment  as  to  8-23-90  order  trans- 
mitted to  OAL  1 1-20-90  and  filed  12-17-90  (Register  91 ,  No.  5). 


Page  343 


Register  95,  No.  45;  11-10-95 


§  50301.4 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


§  50301 .4.    Documentation  of  Status  as  an  Amnesty  Alien. 

(a)  Aliens  whose  status  has  been  adjusted  in  accordance  with  Immigra- 
tion and  Nationality  Act  sections  210,  210A  or  254A  (8  USC  sections 
1160,  1 161  or  1255a)  who  are  applying  for  full  Medi-Cal  benefits  shall 
present  one  of  the  following  INS  documents: 

(1)  Aliens  granted  lawful  temporary  resident  status:  Temporary  Resi- 
dent Card,  INS  Form  1-688. 

(2)  Aliens  granted  lawful  permanent  resident  status:  Alien  Registra- 
tion Receipt  Card,  INS  Form  1-551  or  an  INS  Form  1-688  with  a  sticker 
on  the  back  which  reads  "Temporary  evidence  of  lawful  admission  for 
permanent  residence  and  employment  authorization.  Valid  for  1  year 
from  the  expiration  date  on  the  reverse  of  this  1-688 Form  1-688  Ext." 

(3)  Aliens  whose  INS  documents  have  been  lost  or  stolen  or  are  un- 
readable: An  individual  Fee  Register  Receipt  (INS  Form  G-71 1)  which 
shows  the  person  has  applied  for  replacement  of  a  lost,  stolen  or  unread- 
able 1-688  or  1-551. 

(4)  Aliens  who  were  issued  an  1-688  extension  sticker  wliich  subse- 
quently was  lost  or  stolen  or  which  became  unreadable:  an  1-94  (Arrival- 
Departure  Record)  with  the  stamp:  "PROCESSED  FOR  1-551.  TEMPO- 
RARY EVIDENCE  OF  LAWFUL  ADMISSION  FOR  PERMANENT 

RESIDENCE.  VALID  UNTIL ."  (The  expiration  date 

is  one  year  from  the  date  lawful  permanent  residence  status  was  granted.) 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  and  Section  9,  Chapter  1 441,  Statutes  of  1 988.  Reference:  Sections  14007.5 
and  140 11,  Welfare  and  institutions  Code. 

History 

1 .  New  section  filed  1 1-14-89  as  an  emergency  pursuant  to  section  9  of  chapter 
1441  of  the  Statutes  of  1988;  operative  1 1-14-89  (Register  89,  No.  48).  A  Cer- 
tificate of  Compliance  must  be  transinitted  to  OAL  within  120  days  or  emergen- 
cy language  will  be  repealed  on  3-14-90. 

2.  New  section  refiled  3-8-90  as  an  emergency  pursuant  to  section  9  of  chapter 
1441  of  the  Statutes  of  1988;  operative  3-1 3-90  (Register90.  No.  12).  A  Certifi- 
cate of  Compliance  must  be  transmitted  to  OAL  within  1 20  days  or  emergency 
language  will  be  repealed  on  7-11-90. 

3.  Certificate  of  Compliance  as  to  3-8-90  order  transmitted  to  OAL  7-5-90  and 
disapproved  8-6-90  (Register  90,  No.  42). 

4.  Repealer  and  new  section  filed  8-23-90  as  an  emergency  pursuant  to  section 
9  of  chapter  1441  of  the  Statutes  of  1988;  operative  8-23-90  (Register  90,  No. 
42).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  12-21-90  or 
emergency  language  will  be  repealed  by  operation  of  law  on  the  following  day. 

5.  Certificate  of  Compliance  including  amendment  as  to  8-23-90  order  trans- 
mitted to  OAL  11-20-90  and  filed  12-17-90  (Register  91,  No.  5). 

§  50301 .5.    Opportunity  to  Document  Satisfactory 
Immigration  Status. 

(a)  Alien  applicants  for  full  Medi-Cal  benefits  must  present  docu- 
ments from  INS  or  an  order  issued  by  the  District  Director  of  INS,  the  Ex- 
ecutive Office  of  Immigration  Review,  or  a  federal  court  which  serve  as 
reasonable  evidence  of  satisfactory  immigration  status  for  Medi-Cal 
purposes.  After  they  are  informed  of  this  fact,  they  shall  have  30  calendar 
days,  or  the  time  it  actually  takes  the  county  department  to  process  their 
Medi-Cal  applications,  whichever  is  longer,  to  submit  such  documents. 
The  30-day  period  begins  at  the  time  the  applicant  submits  a  completed 
form  MC  13  (5/89)  containing  a  declaration  in  writing,  under  penalty  of 
perjury,  which  attests  to  his  or  her  status  as  an  alien. 

(b)  Applicants  who  do  not  present  documentation  indicating  satisfac- 
tory immigration  status  within  the  period  prescribed  in  subsection  (a),  are 
eligible  for  restricted  Medi-Cal  benefits  if  they  meet  all  other  program 
requirements. 

(c)  The  county  department  shall  provide  adequate  notice  to  the  indi- 
vidual of  any  adverse  action  and  shall  accord  to  the  individual  an  oppor- 
tunity for  a  hearing  in  accordance  with  the  Department  of  Social  Services 
Manual  of  Policies  and  Procedures  sections  22-017,  22-021  and 
22-022. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institufions 
Code;  and  Section  9,  Chapter  1441,  Statutes  of  1988.  Reference:  Sections  10950 
to  10965,  inclusive,  14007.5  and  1401 1,  Welfare  and  Institufions  Code. 

History 

1 .  New  section  filed  1 1-14-89  as  an  emergency  pursuant  to  section  9  of  chapter 
1441  of  the  Statutes  of  1988;  operafive  1 1-14-89  (Register  89,  No.  48).  A  Cer- 


tificate of  Compliance  must  be  transmitted  to  OAL  within  120  days  or  emergen- 
cy language  will  be  repealed  on  3-14-90. 

2.  New  section  refiled  3-8-90  as  an  emergency  pursuant  to  section  9  of  chapter 
1441  of  the  Statutes  of  1988;  operative  .3-1 3-90  (Register  90.  No.  12).  A  Certifi- 
cate of  Compliance  must  be  transmitted  to  OAL  within  120  days  or  emergency 
language  will  be  repealed  on  7-1 1-90. 

3.  Certificate  of  Compliance  as  to  3-8-90  order  transmitted  to  OAL  7-5-90  and 
disapproved  8-6-90  (Register  90,  No.  42). 

4.  Repealer  and  new  section  filed  8-23-90  as  an  emergency  pursuant  to  secfion 
9  of  chapter  1441  of  the  Statutes  of  1988;  operative  8-23-90  (Register  90,  No. 
42).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  12-21-90  or 
emergency  language  will  be  repealed  by  operation  of  law  on  the  following  day. 

5.  Certificate  of  Compliance  including  amendment  as  to  8-23-90  order  trans- 
mitted to  OAL  1 1-20-90  and  filed  12-17-90  (Register  91.  No.  5). 

§  50301 .6.    Verification  of  Satisfactory  Immigration  Status. 

(a)  "Satisfactory  immigration  status"  for  Medi-Cal  purposes  means 
lawful  admission  for  permanent  residence  in  the  United  States,  status  as 
an  alien  permanently  residing  in  the  U.S.  under  color  of  law,  or  status  as 
an  amnesty  alien. 

(b)  The  authenticity  of  all  INS-issued  documents  presented  as  reason- 
able evidence  of  such  status  shall  be  verified  through  the  Systematic 
Alien  Verification  of  Entitlements  (SAVE)  system  operated  by  INS  or  by 
direct  contact  with  INS  officials. 

(c)  Applicants  for  full  Medi-Cal  benefits  who  have  declared  them- 
selves to  be  aliens,  must  also  declare  in  writing  whether,  to  the  best  of 
their  knowledge  and  belief,  they  have  a  satisfactory  immigration  status. 
Such  aliens  shall  present  INS-issued  documents  which  indicate  their  sta- 
tus. At  least  one  of  these  documents  should  contain  an  alien  registration 
or  alien  admission  number. 

(d)  A  primary  SAVE  system  verification  shall  be  used  to  access  the 
biographical/immigration  status  computer  record  contained  in  the  Alien 
Status  Verification  Index  maintained  by  INS.  This  procedure  shall  be 
used  to  verify  the  status  of  all  aliens  claiming  satisfactory  immigration 
status  who  present  an  INS-issued  document  which  contains  an  alien  reg- 
istration or  alien  admission  number. 

(e)  The  secondary  SAVE  system  verification  procedure  shall  be  used 
to  forward  copies  of  original  INS  documents  in  cases  where: 

(1)  A  primary  check  of  the  Alien  Status  Verification  Index  instructs 
the  county  department  to  "Institute  secondary  verification." 

(2)  The  document  presented  indicates  immigration  status  but  does  not 
include  an  alien  registration  or  alien  admission  number. 

(3)  The  Alien  Status  Verificadon  Index  record  includes  the  alien  regis- 
tration or  admission  number  on  the  document  presented  by  the  alien  but 
does  not  match  other  information  contained  in  the  document. 

(4)  The  document  is  suspected  to  be  counterfeit  or  to  have  been  altered. 

(5)  The  document  includes  an  alien  registration  number  in  the  A60  000 
000  (not  yet  issued)  or  A80  000  000  (illegal  border  crossing)  series. 

(6)  The  document  is  a  fee  receipt  from  INS  for  replacement  of  a  lost, 
stolen  or  unreadable  INS  document. 

(7)  The  document  is  one  of  the  following:  an  INS  Form  1-1 8  lb  notifi- 
cation letter  issued  in  connection  with  an  INS  Form  I-l  81  Memorandum 
of  Creadon  of  Record  of  Permanent  Residence,  an  Arrival-Departure 
Record  (INS  Form  1-94)  or  a  foreign  passport  stamped  "PROCESSED 
FOR  1-551,  TEMPORARY  EVIDENCE  OF  LAWFUL  PERMANENT 
RESIDENCE"  that  INS  issued  more  than  one  year  before  the  date  of 
applicadon  for  Medi-Cal. 

(f)  The  status  of  amnesty  ahens  who  are  eligible  only  for  restricted 
Medi-Cal  benefits  because  they  are  not  aged,  blind,  disabled  or  under  18 
years  of  age,  shall  be  verified  through  the  SAVE  system;  provided,  how- 
ever, that  the  county  department  shall  not  require  or  request  an  applicant 
for  or  beneficiary  of  restricted  Medi-cal  benefits  to  disclose  their  citizen- 
ship or  immigradon  status,  birthplace,  country  of  citizenship,  alien  regis- 
tration number  and/or  ahen  admission  number,  date  of  first  entry  into  the 
United  States,  name  upon  first  entry  into  the  United  States,  or  whether 
they  have  a  Social  Security  Number. 

(g)  Full  Medi-Cal  benefits  received  pending  completion  of  a  determi- 
nation of  immigradon  status  by  INS  shall  be  reduced  to  restricted  Medi- 
Cal  benefits  upon  receipt  of  notice  from  the  SAVE  system,  from  an  INS 


Page  344 


Register  95,  No.  45;  11-10-95 


Title  22 


Health  Care  Services 


§  50302.2 


• 


official,  or  the  applicant/beneficiary  of  a  lack  of  satisfactory  immigration 
status. 

(h)  The  county  department  shall  provide  adequate  notice  to  the  indi- 
vidual of  any  adverse  action  and  shall  accord  to  the  individual  an  oppor- 
tunity for  a  hearing  in  accordance  with  the  Department  of  Social  Services 
Manual  of  Policies  and  Procedures  and  Procedures  sections  22-017, 
22-021  and  22-022. 

NOTE:  Authority  cited:  Sections  10725  and  14]  24.5,  Welfare  and  Institutions 
Code;  and  Section  9,  Chapter  1441,  Statutes  of  1988.  Reference:  Sections  10950 
to  10965,  inclusive,  14007.5  and  1401 1,  Welfare  and  Institutions  Code;  and  the 
Crespin  v.  Kiz.er  court  order  (Alameda  County  Superior  Court,  December  16, 
1992). 

History 

1.  New  section  filed  1 1-14-89  as  an  emergency  pursuant  to  section  9  of  chapter 
1441  of  the  Statutes  of  1988;  operative  11-14-89  (Register  89,  No.  48).  A  Cer- 
tificate of  Compliance  must  be  transmitted  to  OAL  within  1 20  days  or  emergen- 
cy language  will  be  repealed  on  3-14-90. 

2.  New  section  refiled  3-8-90  as  an  emergency  pursuant  to  section  9  of  chapter 
1 44 1  of  the  Statutes  of  1988;  operative  3-1 3-90  (Register  90,  No.  12).  A  Certifi- 
cate of  Compliance  must  be  transmitted  to  OAL  within  120  days  or  emergency 
language  will  be  repealed  on  7-1 1  -90. 

3.  Certificate  of  Compliance  as  to  3-8-90  order  transmitted  to  OAL  7-5-90  and 
disapproved  8-6-90  (Register  90,  No.  42). 

4.  Repealer  and  new  section  filed  8-23-90  as  an  emergency  pursuant  to  secfion 
9  of  chapter  1441  of  the  Statutes  of  1988;  operative  8-23-90  (Register  90,  No. 
42).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  12-21-90  or 
emergency  language  will  be  repealed  by  operation  of  law  on  the  following  day. 

5.  Certificate  of  Compliance  including  amendment  as  to  8-23-90  order  trans- 
mitted to  OAL  1 1-20-90  and  filed  12-17-90  (Register  91,  No.  5). 

6.  Amendment  of  subsecfion  (f)  and  Note  filed  5-17-93  as  an  emergency  with 
Secretary  of  State  by  the  Department  of  Health  Services;  operafive  5-17-93. 
Submitted  to  OAL  forprintinsr  only  pursuant  to  1992  Senate  Bill  485  (Register 
93,  No.  21). 

§  50302.    Restricted  Medi-Cal  Benefits  for  Certain  Aliens. 

(a)  "Restricted  Medi-Cal  benefits"  to  certain  applicants  and  beneficia- 
ries means  program-covered  services  to  treat  an  emergency  medical  con- 
dition as  defined  in  section  14007.5(d)  of  the  Welfare  and  Institutions 
Code  and  section  440.255  of  title  42  of  the  Code  of  Federal  Regulations, 
and  pregnancy-related  services,  as  defined  in  section  1(g)  of  chapter 
1441  of  the  Statutes  of  1988  and  section  440.255  of  title  42  of  the  Code 
of  Federal  Regulations. 

(b)  To  be  eligible  for  restricted  Medi-Cal  benefits,  an  Applicant  or 
beneficiary  shall  be  a  California  resident,  as  specified  in  section  50320, 
who  is  one  of  the  following: 

(1)  An  alien  who  lacks  a  document  from  INS  or  an  order  issued  by  a 
District  Director  of  INS,  the  Executive  Office  of  Immigration  Review, 
or  a  federal  court  that  serves  as  reasonable  evidence  of  satisfactory  immi- 
gration status. 

(2)  A  nonimmigrant  alien  legally  admitted  to  the  U.S.  for  a  limited  pe- 
riod. 

(3)  An  amnesty  alien  whose  status  has  been  adjusted  to  lawful  tempo- 
rary resident  or  lawful  permanent  resident  in  accordance  with  section 
210, 210A,  or  245A  of  the  Immigration  and  Nationality  Act  (8  USC  sec- 
tion 1160, 1161,  or  1255a)  who  is  not  eligible  for  full  Medi-Cal  benefits 
under  these  regulations. 

(c)  Alien  applicants  for  restricted  Medi-Cal  benefits  who  lack  docu- 
mentation of  satisfactory  immigration  status  or  who  are  nonimmigrant 
aliens  shall  meet  all  other  requirements  for  program  eligibility  except  for 
possessing  or  having  applied  for  an  SSN. 

(d)  Applicants  for  restricted  Medi-Cal  benefits  who  are  amnesty  al- 
iens must  possess  or  have  applied  for  an  SSN. 

(e)  The  Systematic  Alien  Verification  for  Entitlements  (SAVE)  sys- 
tem operated  by  INS  shall  not  be  used  to  verify  the  immigration  status  of 
persons  applying  for  restricted  Medi-Cal  benefits  unless  these  persons 
indicate  that  they  are  amnesty  aliens. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code;  and  Section  9,  Chapter  1441,  Statutes  of  1988.  Reference:  Secfions  14007.5 
and  1401 1,  Welfare  and  Institutions  Code. 

History 
I.  New  section  filed  1 1-14-89  as  an  emergency  pursuant  to  section  9  of  chapter 
1441  of  the  Statutes  of  1988;  operative  1 1-14-89  (Register  89,  No.  48).  A  Cer- 
tificate of  Compliance  must  be  transmitted  to  OAL  within  120  days  or  emergen- 
cy language  will  be  repealed  on  3-14-90. 


2.  New  secfion  refiled  3-8-90  as  an  emergency  pursuant  to  section  9  of  chapter 
1 44 1  of  the  Statutes  of  1 988;  operafive  3-1 3-90  (Register  90,  No.  1 2).  A  Certifi- 
cate of  Compliance  must  be  transmitted  to  OAL  wirhin  1 20  days  or  emergency 
language  will  be  repealed  on  7-1 1-90. 

3.  Certificate  of  Compliance  as  to  3-8-90  order  transmitted  to  OAL  7-5-90  and 
disapproved  8-6-90  (Register  90,  No.  42). 

4.  Repealer  and  new  secfion  filed  8-23-90  as  an  emergency  pursuant  to  section 
9  of  chapter  1441  of  the  Statutes  of  1988;  operative  8-23-90  (Register  90,  No. 
42).  A  Certificate  of  CompHance  must  be  transmitted  to  OAL  byl  2-2 1-90  or 
emergency  language  will  be  repealed  by  operation  of  law  on  rhe  following  day. 

5.  Certificate  of  Compliance  including  amendment  as  to  8-23-90  order  trans- 
mitted to  OAL  11-20-90  and  filed  12-17-90  (Register  91,  No.  5). 

§  50302.1.     Limitations  on  Medi-Cal  Benefits  for  Aliens. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institufions 
Code.  Reference:  Sections  41 1,  431  and  432  of  the  Personal  Responsibility  and 
Work  Opportunity  Reconciliation  Act  of  1996  (Pub.L.  104-193);  Sections  501 
and  508  of  Division  C  (the  "Immigration  Reform  and  Immigrant  Responsibility 
Act  of  1996")  of  the  Omnibus  Consolidated  Appropriations  Act,  1997  (Pub.L 
104-208);  Sections  5302,  5562,  5571  and  5581  of  the  Balanced  Budget  Act  of 
1997  (Pub.L.  1 05-33)  as  amended  by  Sections  401  and  403  of  the  Taxpayer  Relief 
Act  of  1 997  (Pub.L.  105-34.);  8  USC  Sections  1 1 01  (a)(  1 5)  and  1 62 1  (b);  Sections 
14007.5  and  1401 1,  Welfare  and  Institufions  Code;  and  Secfion  1,  Chapter  1441, 
Statutes  of  1988. 

History 

1 .  New  section  filed  1 1-5-96  as  an  emergency;  operative  12-1-96  (Register  96, 
No.  45).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  3-31-97 
or  emergency  language  will  be  repealed  by  operation  of  law  on  the  following 
day. 

2.  Repealed  by  operation  of  Government  Code  secfion  1 1346.1(g)  (Register  97, 
No.  49). 

3.  New  secfion  filed  12-1-97;  operative  12-1-97  pursuant  to  Government  Code 
section  11343.4(d)  (Register  97,  No.  49). 

4.  Change  without  regulatory  effect  repealing  section  filed  10-5-99  pursuant  to 
secfion  100,  tifie  1,  California  Code  of  Regulafions  (Register  99,  No.  41). 

§  50302.2.     Limitations  on  Medi-Cal  Benefits  for  Aliens. 

(a)  Pursuant  to  Section  41 1  of  the  Personal  Responsibility  and  Work 
Opportunity  Reconciliation  Act  of  1996  (8  USC  section  161 1),  and  not- 
withstanding any  other  provision  of  this  division,  aliens  who  are  not  qual- 
ified aliens,  nonimmigrant  aliens  under  the  Immigration  and  Nationality 
Act  (INA)  (8  USC  section  1 101  et  seq.),  or  aliens  paroled  into  the  United 
States  under  Section  212(d)(5)  of  the  INA  (8  USC  section  1182(d)(5)), 
for  less  than  one  year,  are  not  eligible  to  receive  the  state-only  funded 
long-term  care  services  described  in  subdivision  (f)  of  Secfion  1  of  Chap- 
ter 1441  of  the  Statutes  of  1988. 

(b)  A  qualified  alien  is  an  alien  who,  at  the  time  he  or  she  applies  for, 
receives,  or  attempts  to  receive  a  public  benefit,  is  any  of  the  following: 

(1)  An  alien  lawfully  admitted  for  permanent  residence  under  the  IN  A 
(8  USC  section  1101  et  seq.). 

(2)  An  alien  who  is  granted  asylum  under  Section  208  of  the  INA  (8 
USC  secfion  1 158). 

(3)  A  refugee  who  is  admitted  to  the  United  States  under  Secfion  207 
of  the  INA  (8  USC  secfion  1 157). 

(4)  An  alien  who  is  paroled  into  the  United  States  under  Secfion 
212(d)(5)  of  the  INA  (8  USC  secfion  1182(d)(5))  for  a  period  of  at  least 
one  year. 

(5)  An  alien  whose  deportafion  is  being  withheld  under  Secfion  243(h) 
of  the  INA  as  in  effect  immediately  before  the  effecfive  date  of  Secfion 
307  of  Division  C  of  Pubfic  Law  104-208  or  Secfion  241(b)(3)  of  the  Act 
(as  amended  by  Secfion  305(a)  of  Division  C  of  Public  Law  104-208). 

(6)  An  alien  who  is  granted  condifional  entry  pursuant  to  Secfion 
203(a)(7)  of  the  INA  as  in  effect  prior  to  April  1 ,  1980.  (See  editorial  note 
under  8  USC  section  1101,  "Effecfive  Date  of  1980  Amendment".) 

(7)  An  ahen  who  is  a  Cuban  and  Haitian  entrant  (as  defined  in  Section 
501(e)  of  the  Refugee  Educafion  Assistance  Act  of  1980). 

(8)  An  alien  who  meets  all  of  the  conditions  of  subparagraphs  (A),  (B), 
(C),  and  (D)  below: 

(A)  The  alien  has  been  battered  or  subjected  to  extreme  cruelty  in  the 
United  States  by  a  spouse  or  a  parent,  or  by  a  member  of  the  spouse's  or 
parent's  family  residing  in  the  same  household  as  the  alien,  and  the 
spouse  or  parent  of  the  alien  consented  to,  or  acquiesced  in,  such  battery 
or  cruelty. 


Page  345 


Register  99,  No.  41;  10-8-99 


§  50302.2 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


(B)  There  is  a  substantial  connection  between  such  battery  or  cruelty 
and  the  need  for  the  benefits  to  be  provided. 

(C)  The  alien  has  been  approved  or  has  a  petition  pending  which  sets 
forth  a  prima  facie  case  for: 

J.  status  as  a  spouse  or  child  of  a  United  States  citizen  pursuant  to 
clause  (ii),  (iii),  or  (iv)  of  Section  204(a)(1)(A)  of  the  INA  (8  USC  section 
1154(a)(1)(A)), 

2.  classification  pursuant  to  clause  (ii)  or  (iii)  of  Section  204(a)(1)(B) 
of  the  INA  (8  use  section  1154), 

3.  suspension  of  deportation  and  adjustment  of  status  pursuant  to  Sec- 
tion 244(a)(3)  of  the  INA  (8  USC  section  1 254),  as  in  effect  prior  to  April 
1,  1997, 

4.  status  as  a  spouse  or  child  of  a  United  States  citizen  pursuant  to 
clause  (i)  of  Section  204(a)(1)(A)  of  the  INA  (8  USC  section 
1154(a)(1)(A))  or  classification  pursuant  to  clause  (i)  of  Section 
204(a)(1)(B)  of  the  INA  (8  USC  section  1 154(a)(1)(B)),  or 

5.  Cancellation  of  removal  pursuant  to  Section  240A(b)(2)of  thelNA. 

(D)  For  the  period  for  which  benefits  are  sought,  the  individual  respon- 
sible for  the  battery  or  cruelty  does  not  reside  in  the  same  household  or 
family  eligibihty  unit  as  the  individual  subjected  to  the  battery  or  cruelty. 

(9)  An  alien  who  meets  all  of  the  conditions  of  subparagraphs  (A),  (B), 
(C),  (D)  and  (E)  below: 

(A)  The  alien  has  a  child  who  has  been  battered  or  subjected  to  extreme 
cruelty  in  the  United  States  by  a  spouse  or  a  parent  of  the  alien  (without 
the  active  participation  of  the  alien  in  the  battery  or  caielty),  or  by  a  mem- 
ber of  the  spouse's  or  parent's  family  residing  in  the  same  household  as 
the  alien,  and  the  spouse  or  parent  consented  or  acquiesced  to  such  bat- 
tery or  cruelty. 

(B)  The  alien  did  not  actively  participate  in  such  battery  or  cruelty. 

(C)  There  is  a  substantial  connection  between  such  battery  or  cruelty 
and  the  need  for  the  benefits  to  be  provided. 

(D)  The  alien  meets  the  requirements  of  subsection  (b)(8)(C)  above. 

(E)  For  the  period  for  which  benefits  are  sought,  the  individual  respon- 
sible for  the  battery  or  cruelty  does  not  reside  in  the  same  household  or 
family  eligibility  unit  as  the  child  subjected  to  the  battery  or  cruelty. 

(10)  An  alien  child  who  meets  all  of  the  conditions  of  subparagraphs 
(A),  (B),  and  (C)  below: 

(A)  The  alien  child  resides  in  the  same  household  as  a  parent  who  has 
been  battered  or  subjected  to  extreme  cruelty  in  the  United  States  by  that 
parent's  spouse  or  by  a  member  of  the  spouse's  family  residing  in  the 
same  household  as  the  parent  and  the  spouse  consented  or  acquiesced  to 
such  battery  or  cruelty. 

(B)  There  is  a  substantial  connection  between  such  battery  or  cruelty 
and  the  need  for  the  benefits  to  be  provided. 

(C)  The  alien  child  meets  the  requirements  of  subsection  (b)(8)(C) 
above. 

(c)  For  purposes  of  this  section,  there  is  a  "substantial  connection  be- 
tween such  battery  or  cruelty  and  the  need  for  benefits  to  be  provided" 
if  the  alien  declares,  and  the  county  welfare  department  verifies,  any  of 
the  following  circumstances: 

(1)  The  alien  or  the  alien's  child  is  receiving  cash  assistance  based  on 
battery  or  extreme  cruelty; 

(2)  The  benefits  are  needed  due  to  a  loss  of  financial  support  resulting 
from  the  alien's  and/or  his  or  her  child's  separation  from  the  abuser; 

(3)  The  benefits  are  needed  because  the  alien  or  his  or  her  child  re- 
quires medical  attention  or  mental  health  counseling,  or  has  become  dis- 
abled, as  a  result  of  the  battery  or  cruelty; 

(4)  The  benefits  are  needed  to  provide  medical  care  during  an  un- 
wanted pregnancy  resulting  from  the  abuser's  sexual  assault  or  abuse  of, 
or  relationship  with,  the  alien  or  his  or  her  child,  and/or  to  care  for  any 
resulting  children;  or 

(5)  The  medical  coverage  and/or  health  care  services  are  needed  to  re- 
place medical  coverage  or  health  care  services  the  applicant  or  child  had 
when  living  with  the  abuser. 

(d)  For  purposes  of  this  section,  "nonimmigrant"  is  defined  the  same 
as  in  Section  1101(a)(15)  of  the  INA  (8  USC  section  1101(a)(15)). 


(e)  For  purposes  of  establishing  eligibility  for  state-only  funded  long- 
term  care  services  described  in  subdivision  (f)  of  Section  1  of  Chapter 
1441  of  the  Statutes  of  1 988,  all  of  the  following  requirements  must  be 
met: 

( 1 )  The  alien  must  declare  himself  or  herself  to  be  a  qualified  alien  un- 
der subsection  (b),  a  nonimmigrant  alien  under  subsection  (d),  or  an  alien 
paroled  into  the  United  States  for  less  than  one  year  under  Section 
212(d)(5)  of  the  INA  (8  USC  section  1 182(d)(5)).  The  alien  shall  declare 
that  status  through  use  of  the  "Supplemental  Alienage  and  Immigration 
Status  Declaration"  MC  13S  (12/96). 

(2)  The  alien  must  present  documents  issued  by  or  acceptable  to  the 
Immigrafion  and  Naturalization  Service  (INS)  which  serve  as  reasonable 
evidence  of  the  alien's  declared  status. 

(3)  The  alien  must  complete  and  sign  Form  MC  13S  (12/96). 

(4)  The  documentation  presented  by  the  alien  as  reasonable  evidence 
of  the  alien's  declared  immigration  status  must  be  submitted  to  the  INS 
for  verification  through  the  Systemafic  Ahen  Verification  for  Entitle- 
ments (SAVE)  system  procedures  as  follows: 

(A)  A  primary  SAVE  system  verificadon  must  be  used  to  access  the 
biographical/immigration  status  computer  record  contained  in  the  Alien 
Status  Verificafion  Index  maintained  by  the  INS.  Subject  to  subpara- 
graph (B),  this  procedure  must  be  used  to  verify  the  status  of  all  aliens 
who  claim  to  be  qualified  aliens  and  who  present  an  INS-issued  docu- 
ment that  contains  an  alien  registrafion  or  alien  admission  number. 

(B)  The  secondary  SAVE  system  verification  procedure  must  be  used 
to  forward  copies  of  original  INS  documents  evidencing  an  alien's  status 
as  a  qualified  alien,  as  a  nonimmigrant  ahen  under  the  INA,  or  as  an  alien 
paroled  into  the  United  States  under  Secfion  21 2(d)(5)  of  the  INA  (8  USC 
secfion  1 182(d)(5)),  for  less  than  one  year  in  any  of  the  following  cases: 

1.  a  primary  check  of  the  Alien  Status  Verificafion  Index  instructs  the 
county  department  to  "Insfitute  secondary  verification." 

2.  The  document  presented  indicates  immigration  status  but  does  not 
include  an  alien  registration  or  alien  admission  number. 

3.  The  Ahen  Status  Verification  Index  record  includes  the  alien  regis- 
tration or  admission  number  on  the  document  presented  by  the  alien  but 
does  not  match  other  information  contained  in  the  document. 

4.  The  document  is  suspected  to  be  counterfeit  or  to  have  been  altered. 

5.  The  document  includes  an  alien  registrafion  number  in  the  A60  000 
000  (not  yet  issued)  or  A80  000  000  (illegal  border  crossing)  series. 

6.  The  document  is  a  fee  receipt  from  INS  for  replacement  of  a  lost, 
stolen  or  unreadable  INS  document. 

7.  The  document  is  one  of  the  following:  an  INS  Form  1-18  lb  nofifica- 
tion  letter  issued  in  connecfion  with  an  INS  Form  1-181  Memorandum 
of  Creation  of  Record  of  Permanent  Residence,  an  Arrival-Departure 
Record  (INS  Form  1-94)  or  a  foreign  passport  stamped  "PROCESSED 
FOR  1-551 ,  TEMPORARY  EVIDENCE  OF  LAWFUL  PERMANENT 
RESIDENCE"  that  INS  issued  more  than  one  year  before  the  date  of 
application  for  Medi-Cal. 

(5)  Verification  of  the  alien's  declared  status  must  be  received  from 
the  INS  before  eligibility  for  state-only  funded  long-term  care  services 
is  established. 

(f)  A  nonprofit  charitable  organizafion  that  provides  federal,  state,  or 
local  public  benefits  shall  not  be  required  to  determine,  verify,  or  other- 
wise require  proof  of  eUgibility  of  any  applicant  or  beneficiary  with  re- 
spect to  his  or  her  immigration  status  or  alienage. 

(g)  Nothing  in  this  section  shall  be  construed  to  withdraw  eligibility 
for  state  public  health  assistance  for  immunizations  with  respect  to  im- 
munizable  diseases  and  for  testing  and  treatment  of  symptoms  of  com- 
municable diseases  whether  or  not  such  symptoms  are  caused  by  a  com- 
municable disease. 

(h)  An  alien  who  is  a  quahfied  alien  pursuant  to  paragraphs  (8),  (9)  or 
(10)  of  subsecfion  (b),  will  remain  eligible  for  Medi-Cal  benefits  as  long 
as  the  need  for  benefits  related  to  the  battery  or  cruelty  is  necessary  as  de- 
termined by  the  county  welfare  department,  and  the  alien  confinues  to 
meet  all  Medi-Cal  program  eligibility  requirements.  The  county  eligibil- 
ity worker  shall  review  the  alien's  circumstances  to  evaluate  the  benefi- 


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Register  99,  No.  41;  10-8-99 


Title  22 


Health  Care  Services 


§  50310 


• 


• 


ciary's  continued  need  for  Medi-Cal  benefits  at  the  annual  redetermina- 
tion. 

(i)(l)  Any  alien  who  was  made  eligible  for  state-only  tiinded  long- 
term  care  services  for  the  month  in  which  this  section  becomes  effective 
and  whose  services  are  terminated,  suspended,  or  reduced,  pursuant  to 
subsection  (a),  is  entitled  to  a  hearing,  pursuant  to  Welfare  and  Institu- 
tions Code  Section  10950  and  Title  22,  California  Code  of  Regulations, 
Section  50951,  on  the  issue  of  whether  the  alien  is  a  qualified  alien  as  de- 
fined under  subsection  (b),  a  nonimmigrant  alien  as  defined  under  sub- 
section (d),  or  an  alien  paroled  into  the  United  States  for  less  than  one  year 
under  Section  212(d)(5)  of  the  INA  or  on  the  issue  of  whether  a  service 
requested  by  the  alien  falls  within  one  of  the  exceptions  provided  in  8 
use  section  1621(b). 

(2)  Subject  to  the  provisions  of  Welfare  and  Institutions  Code  Section 
10950  and  Title  22,  California  Code  of  Regulations,  Section  50951,  any 
alien  whose  application  for  Medi-Cal  benefits  is  denied  for  any  reason, 
including  the  provisions  of  subsection  (a),  is  entitled  to  a  hearing. 
NOTE:  Authority  cited:  Sections  10723  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  8  USC  Sections  1 101,  161 1, 1621, 1641  and  1642;  Sections  501 
and  508  of  Division  C  (the  "Immigration  Reform  and  Immigrant  Responsibility 
Act  of  1996")  of  the  Omnibus  Consolidated  Appropriations  Act,  1997  (Pub.L. 
104-208);  Sections  5302,  5562,  5571  and  5581  of  the  Balanced  Budget  Act  of 
1997  (Pub.L.  105-33)  as  amended  by  Sections  401  and  403  of  the  Taxpayer  Relief 
Act  of  1997  (Pub.L.  105-34.);  Sections  14007.5  and  14011,  Welfare  and  Institu- 
tions Code;  and  Section  1,  Chapter  1441,  Statutes  of  1988. 

History 
1.  New  section  filed  3-4-98;  operative  9-4-98  (Register  98,  No.  10). 

§  50303.    Alien  Status  Verification. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  and  Section  9,  Chapter  1441 ,  Statutes  of  1988.  Reference:  Section  14007.5, 
Welfare  and  Institutions  Code;  and  Sections  1,  2  and  3,  Chapter  1441,  Statutes  of 
1988. 

History 

1 .  Repealer  and  new  section  filed  10-20-88  as  an  emergency;  operative  10-20-88 
(Register  88,  No.  45).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL 
within  120  days  or  emergency  language  will  be  repealed  on  2-20-89. 

2.  Repealer  and  new  section  refiled  2-10-89  as  an  emergency;  operative  2-15-89 
(Register  89,  No.  8).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL 
within  120  days  or  emergency  language  will  be  repealed  on  6-1 5-89. 

3.  Repealer  and  new  section  refiled  6-5-89  as  an  emergency;  operative  6-15-89 
(Register  89,  No.  23).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL 
within  120  days  or  emergency  language  will  be  repealed  on  10-13-89. 

4.  Certificate  of  Compliance  transmitted  to  OAL  10-12-89  and  disapproved  by 
OAL  on  1 1-13-89  (Register  89,  No.  48). 

5.  Repealer  filed  1 1  -14-89  as  an  emergency  pursuant  to  section  9  of  chapter  1441 
of  the  Statutes  of  1 988;  operative  1 1-14-89  (Register  89,  No.  48).  A  Certificate 
of  Compliance  must  be  transmitted  to  OAL  within  1 20  days  or  emergency  lan- 
guage will  be  repealed  on  3-14-90. 

6.  Repealer  refiled  3-8-90  as  an  emergency  pursuant  to  section  9  of  chapter  1441 
of  the  Statutes  of  1988;  operative  3-13-90  (Register  90,  No.  12).  A  Certificate 
of  Compliance  must  be  transmitted  to  OAL  within  120  days  or  emergency  lan- 
guage will  be  repealed  on  7-1 1-90. 

7.  Certificate  of  Compliance  as  to  3-8-90  order  transmitted  to  OAL  7-5-90  and 
disapproved  8-6-90  (Register  90,  No.  42). 

8.  Repealer  filed  8-23-90  as  an  emergency  pursuant  to  section  9  of  chapter  1441 
of  the  Statutes  of  1988;  operative  8-23-90  (Register  90,  No.  42).  A  Certificate 
of  Compliance  must  be  transmitted  to  OAL  by  12-21-90  or  emergency  lan- 
guage will  be  repealed  by  operation  of  law  on  the  following  day. 

9.  Certificate  of  Compliance  as  to  8-23-90  order  transmitted  to  OAL  11-20-90 
and  filed  12-17-90  (Register  91,  No.  5). 

10.  Editorial  conection  of  printing  error  in  HISTORY  8.  (Register  91,  No.  32). 

§  50304.    Written  Declaration  of  Status  as  a  Citizen  of  tlie 
United  States,  a  National  of  the  United  States, 
or  an  Alien. 

(a)  Individuals  requesting  or  receiving  Medi-Cal  benefits  shall  state 
in  writing,  under  penalty  of  perjury,  whether  they  are  citizens  or  nationals 
of  the  United  States  or  aliens.  In  the  case  of  a  child  under  21  years  of  age, 
the  child's  parent,  caretaker  relafive,  or  legal  guardian  shall  attest  to  this 
fact  on  the  child's  behalf  unless  the  child  is  considered  an  adult  for  Medi- 
Cal  purposes  in  accordance  with  secfions  50014  and  50030(a). 
NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Insfitutions 
Code;  and  Section  9,  Chapter  1441 ,  Statutes  of  1988.  Reference:  Secfions  14007.5 
and  1401 1,  Welfare  and  Institufions  Code. 


History 

1.  Repealer  filed  10-20-88  as  an  emergency;  operative  10-20-88  (Register  88, 
No.  45).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  and  former  section  reinstated  as 
it  existed  prior  to  emergency  repeal  on  2-20-89. 

2.  Repealer  refiled  2-10-89  as  an  emergency;  operative  2-15-89  (Register  89, 
No.  8).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  6-1 5-89. 

3.  Repealer  refiled  6-5-89  as  an  emergency;  operative  6-1 5-89  (Register  89,  No. 
23).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  10-13-89. 

4.  Certificate  of  Compliance  transmitted  to  OAL  10-12-89  and  disapproved  by 
OAL  on  1 1-1 3-89  (Register  89,  No.  48). 

5.  Repealer  and  new  section  filed  1 1-14-89  as  an  emergency  pursuant  to  section 
9  of  chapter  1441  of  the  Statutes  of  1988;  operative  1 1-14-89  (Register  89,  No. 
48).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  3-14-90. 

6.  Repealer  and  new  section  refiled  3-8-90  as  an  emergency  pursuant  to  section 
9of  chapter  1441  of  the  Statutes  of  1988;  operative  3-1 3-90  (Register  90,  No. 
12).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  7-1 1-90. 

7.  Certificate  of  Compliance  as  to  3-8-90  order  transmitted  to  OAL  7-5-90  and 
disapproved  8-6-90  (Register  90,  No.  42). 

8.  Repealer  and  new  section  filed  8-23-90  as  an  emergency  pursuant  to  section 
9  of  chapter  1441  of  the  Statutes  of  1988;  operafive  8-23-90  (Register  90,  No. 
42).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  12-21-90  or 
emergency  language  will  be  repealed  by  operation  of  law  on  the  following  day. 

9.  Certificate  of  Compliance  as  to  8-23-90  order  transmitted  to  OAL  1 1-20-90 
and  filed  12-17-90  (Register  91,  No.  5). 

§  50305.    Documentation  of  an  Alien's  Legal  Status. 

History 

1.  Repealer  filed  10-20-88  as  an  emergency;  operative  10-20-88  (Register  88, 
No.  45).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  and  former  section  reinstated  as 
it  existed  prior  to  emergency  repeal  on  2-20-89. 

2.  Repealer  refiled  2-10-89  as  an  emergency;  operative  2-15-89  (Register  89, 
No.  8).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  6-15-89. 

3.  Repealer  refiled  6-5-89  as  an  emergency;  operafive  6-1 5-89  (Register  89,  No. 
23).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  10-13-89. 

4.  Certificate  of  Compliance  transmitted  to  OAL  10-12-89  and  disapproved  by 
OAL  on  11-13-89  (Register  89,  No.  48). 

5.  Repealer  filed  1 1-14-89  as  an  emergency  pursuant  to  secfion  9  of  chapter  1441 
of  the  Statutes  of  1988;  operative  1 1-14-89  (Register  89,  No.  48).  A  Certificate 
of  Compliance  must  be  transmitted  to  OAL  within  120  days  or  emergency  lan- 
guage will  be  repealed  on  3-14-90. 

6.  Repealer  refiled  3-8-90  as  an  emergency  pursuant  to  section  9  of  chapter  1441 
of  the  Statutes  of  1988;  operafive  3-13-90  (Register  90,  No.  12).  A  Certificate 
of  Compliance  must  be  transmitted  to  OAL  within  1 20  days  or  emergency  lan- 
guage will  be  repealed  on  7-11-90. 

7.  Certificate  of  Compliance  as  to  3-8-90  order  U-ansmitted  to  OAL  7-5-90  and 
disapproved  8-6-90  (Register  90,  No.  42). 

8.  Repealer  filed  8-23-90  as  an  emergency  pursuant  to  section  9  of  chapter  1441 
of  the  Statutes  of  1988;  operative  8-23-90  (Register  90,  No.  42).  A  Certificate 
of  Compliance  must  be  transmitted  to  OAL  by  12-21-90  or  emergency  lan- 
guage will  be  repealed  by  operation  of  law  on  the  following  day. 

9.  Certificate  of  Compliance  as  to  8-23-90  order  transmitted  to  OAL  1 1-20-90 
and  filed  12-17-90  (Register  91,  No.  5). 

§50310.    WR  6  Procedure. 

History 

1.  Repealer  filed  10-20-88  as  an  emergency;  operative  10-20-88  (Register  88, 
No.  45).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  and  former  section  reinstated  as 
it  existed  prior  to  emergency  repeal  on  2-20-89. 

2.  Repealer  refiled  2-10-89  as  an  emergency;  operative  2-15-89  (Register  89, 
No.  8).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  6-15-89. 

3.  Repealer  refiled  6-5-89  as  an  emergency;  operafive  6-15-89  (Register  89,  No. 
23).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  10-13-89. 

4.  Certificate  of  Compliance  transmitted  to  OAL  10-12-89  and  disapproved  by 
OAL  on  1  ]-]  3-89  (Register  89,  No.  48). 

5.  Repealer  filed  1 1-14-89  as  an  emergency  pursuant  to  secfion  9  of  chapter  1441 
of  the  Statutes  of  1988;  operative  11-14-89  (Register  89,  No.  48).  A  Certificate 
of  Compliance  must  be  transmitted  to  OAL  within  120  days  or  emergency  lan- 
guage will  be  repealed  on  3-14-90. 

6.  Repealer  refiled  3-8-90  as  an  emergency  pursuant  to  section  9  of  chapter  1441 
of  the  Statutes  of  1988;  operafive  3-13-90  (Register  90,  No.  12).  A  Certificate 
of  Compliance  must  be  transmitted  to  OAL  within  120  days  or  emergency  lan- 
guage will  be  repealed  on  7-1 1-90. 

7.  Certificate  of  Compliance  as  to  3-8-90  order  transmitted  to  OAL  7-5-90  and 
disapproved  8-6-90  (Register  90,  No.  42). 


Page  346.1 


Register  99,  No.  41;  10-8-99 


§  50311 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


8.  Repealer  filed  8-23-90  as  an  emeigency  pursuant  to  section  9  of  chapter  ]44] 
of  tile  Statutes  of  1988;  operative  8-23-90  (Register  90,  No.  42).  A  Certificate 
of  Compliance  must  be  transmitted  to  OAL  by  12-21-90  or  emergency  lan- 
guage will  be  repealed  by  operation  of  law  on  the  following  day. 

9.  Certificate  of  Compliance  as  to  8-23-90  order  transmitted  to  OAL  1 1-20-90 
and  filed  12-17-90  (Register  91,  No.  5). 

§  5031 1 .    Lawful  Presence  in  the  United  States. 

History 

1.  New  subsection  (c)  filed  12-15-77;  effective  thirtieth  day  thereafter  (Register 
77,  No.  51). 

2.  Repealer  filed  10-20-88  as  an  emergency;  operative  10-20-88  (Register  88, 
No.  45).  A  Certificate  of  Compliance  must  be  transmitted  lo  OAL  within  120 
days  or  emergency  language  will  be  repealed  and  former  section  reinstated  as 
it  existed  prior  to  emergency  repeal  on  2-20-89. 

3.  Repealer  refiled  2-10-89  as  an  emergency;  operative  2-15-89  (Register  89, 
No.  8).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  6-15-89. 

4.  Repealer  refiled  6-5-89  as  an  emergency;  operative  6-1 5-89  (Register  89,  No. 
23).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  lO-l  3-89. 

5.  Certificate  of  Compliance  transmitted  to  OAL  10-12-89  and  disapproved  by 
OAL  on  11-13-89  (Register  89,  No.  48). 

6.  Repealer  filed  11-14-89  as  an  emergency  pursuant  to  secfion  9  of  chapter  1441 
ofthe  Statutes  of  1988;  operative  11-14-89  (Register  89,  No.  48).  A  Certificate 
of  Compliance  must  be  transmitted  to  OAL  within  1 20  days  or  emergency  lan- 
guage will  be  repealed  on  3-14-90. 

7.  Repealer  refiled  3-8-90  as  an  emergency  pursuant  to  section  9  of  chapter  1441 
ofthe  Statutes  of  1988;  operative  3-1 3-90  (Register  90.  No.  12).  A  Certificate 
of  Compliance  must  be  transmitted  to  OAL  within  1 20  days  or  emergency  lan- 
guage will  be  repealed  on  7-1 1-90. 

8.  Certificate  of  Compliance  as  to  3-8-90  order  transmitted  to  OAL  7-5-90  and 
disapproved  8-6-90  (Register  90,  No.  42). 

9.  Repealer  filed  8-23-90  as  an  emergency  pursuant  to  section  9  of  chapter  1441 
ofthe  Statutes  of  1988;  operative  8-23-90  (Register  90,  No.  42).  A  Certificate 
of  Compliance  must  be  transmitted  to  OAL  by  12-21-90  or  emergency  lan- 
guage will  be  repealed  by  operation  of  law  on  the  following  day. 

10.  Certificate  of  Compliance  as  to  8-23-90  order  transmitted  to  OAL  1 1-20-90 
and  filed  12-17-90  (Register  91,  No.  5). 

§  50313.    Legal  Entry  for  a  Limited  Period. 

History 

1.  Repealer  filed  10-20-88  as  an  emergency;  operative  10-20-88  (Register  88, 
No.  45).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  and  former  section  reinstated  as 
it  existed  prior  to  emergency  repeal  on  2-20-89. 

2.  Repealer  refiled  2-10-89  as  an  emergency;  operative  2-15-89  (Register  89, 
No.  8).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  6-13-89. 

3.  Repealer  refiled  6-5-89  as  an  emergency;  operative  6-1 5-89  (Register  89,  No. 
23).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  10-13-89. 

4.  Certificate  of  Compliance  transmitted  to  OAL  10-12-89  and  disapproved  by 
OAL  on  1 1-13-89  (Register  89,  No.  48). 

5.  Repealer  filed  1 1-14-89  as  an  emergency  pursuant  to  section  9  of  chapter  1441 
ofthe  Statutes  of  1988;  operative  1 1-14-89  (Register  89,  No.  48).  A  Certificate 
of  Compliance  must  be  transmitted  to  OAL  within  1 20  days  or  emergency  lan- 
guage will  be  repealed  on  3-14-90. 

6.  Repealer  refiled  3-8-90  as  an  emergency  pursuant  to  section  9  of  chapter  1441 
ofthe  Statutes  of  1988;  operative  3-13-90  (Register  90,  No.  12).  A  Certificate 
of  Compliance  must  be  transmitted  to  OAL  within  1 20  days  or  emergency  lan- 
guage will  be  repealed  on  7-1 1-90. 

7.  Certificate  of  Compliance  as  to  3-8-90  order  transmitted  to  OAL  7-5-90  and 
disapproved  8-6-90  (Register  90,  No.  42). 

8.  Repealer  filed  8-23-90  as  an  emergency  pursuant  to  section  9  of  chapter  1441 
ofthe  Statutes  of  1988;  operative  8-23-90  (Register  90,  No.  42).  A  Certificate 
of  Compliance  must  be  transmitted  to  OAL  by  12-21-90  or  emergency  lan- 
guage will  be  repealed  by  operation  of  law  on  the  following  day. 

9.  Certificate  of  Compliance  as  to  8-23-90  order  transmitted  to  OAL  11-20-90 
and  filed  12-17-90  (Register  91,  No.  5). 

§  50320.    California  Residence — General. 

(a)  California  residence  is  a  requirement  for  Medi-Cal  eligibility. 

(b)  California  residence  shall  be  established  by  either  ofthe  following 
if  the  verification  requirements  of  Section  50320.1  are  met: 

(1)  The  applicant  is  physically  present  and  is  living  in  California  with 
the  intention  to  remain  permanently  or  for  an  indefinite  period. 


(2)  The  applicant  is  physically  present,  is  living  in  California  and  en- 
tered the  State  with  a  job  commitment  or  to  seek  employment,  whether 
or  not  currently  employed. 

(c)  Children  living  with  their  parents  shall  have  their  residence  deter- 
mined as  that  of  their  parents,  except  that  parents  who  do  not  meet  the 
California  residency  requirements  may  establish  California  residence  for 
their  children  if  both  ofthe  following  circumstances  apply.  The  parents: 

(1 )  Intend  for  their  children  to  remain  in  Cahfomia  on  other  than  a  tem- 
porary basis. 

(2)  Have  made  arrangements  for  the  children  to  remain  in  California 
independent  of  the  parents. 

(d)  Family  members  may  establish  separate  residences  without  a  break 
in  marital  or  family  ties.  Only  those  family  members  who  meet  the  re- 
quirements of  this  article  shall  be  eligible  for  Medi-Cal. 

(e)  Once  California  residence  is  established  it  continues  until  resi- 
dence is  established  in  another  state  or  country. 

(f)  A  person's  declaration  on  the  MC  210  Statement  of  Facts  (Medi- 
Cal),  or  on  the  SAWS  2  Statement  of  Facts,  together  with  the  evidence 
required  in  Section  50320. 1 ,  shall  be  accepted  for  purposes  of  establish- 
ing residence  unless  there  is  evidence  to  the  contrary. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institufions 
Code.  Reference:  Section  66,  Chapter  722,  Statutes  of  1 992  and  42  Code  of  Feder- 
al Regulations  435.403. 

History 

1.  Relettering  of  subsection  (c)  to  subsection  (d)  and  new  subsection  (c)  filed 
2-6-80  as  an  emergency;  effective  upon  filing.  A  Certificate  of  Compliance 
must  be  transmitted  to  OAH  within  1 20  days  or  emergency  language  will  be  re- 
pealed on  6-6-80.  (Register  80,  No.  6). 

2.  Certificate  of  Compliance  filed  6-6-80  (Register  80,  No.  23). 

3.  Amendment  filed  10-23-81;  effective  thirtieth  day  thereafter  (Register  81,  No. 

43). 

4.  Amendment  of  subsection  (b)-(b)(2),  (e),  (f)  and  Note  filed  5-17-93  as  an 
emergency  with  Secretary  of  State  by  the  Department  of  Health  Services;  opera- 
tive 5-17-93.  Submitted  to  OAL  for  printing  only  pursuant  to  1992  Senate  Bill 
485(Register93,  No.  21). 

§  50320.1.    California  Residence — Evidence. 

(a)  In  addition  to  the  declaration  of  residence  on  the  MC  210  State- 
ments of  Facts  (Medi-Cal),  or  on  the  SAWS  2  Statement  of  Facts,  Cali- 
fornia residence  is  not  established  unless  both  ofthe  following  conditions 
are  met  as  required  in  Subdivision  50230(f): 

(1)  The  applicant  produces  one  of  the  following: 

(A)  A  current  California  rent  or  mortgage  receipt  or  utility  bill  in  the 
applicant's  name  bearing  the  current  address  of  the  applicant.  Rent  re- 
ceipts provided  by  a  relative  shall  not  be  accepted  for  purfioses  of  Section 
50320.1(a)(1)  in  the  absence  of  other  credible  evidence  that  supports  a 
finding  that  the  applicant  is  a  resident  of  California  pursuant  to  Section 
50320(b)  unless  the  relative  declares  under  penalty  of  perjury  that  the  in- 
formation set  forth  on  the  rent  receipt  provided  by  the  apphcant  is  true 
and  correct. 

(B)  A  current  and  valid  California  motor  vehicle  driver's  license  or 
California  Identification  Card  issued  by  the  California  Department  of 
Motor  Vehicles  in  the  applicant' s  name  bearing  the  current  address  ofthe 
applicant. 

(C)  A  current  and  valid  California  motor  vehicle  registration  in  the 
applicant's  name  bearing  the  current  address  ofthe  applicant. 

(D)  A  document  showing  that  the  applicant  is  employed  in  this  state. 

(E)  A  document  showing  that  the  applicant  has  registered  with  a  public 
or  private  employment  service  in  this  state. 

(F)  Evidence  that  the  applicant  has  enrolled  his  or  her  children  in  a 
school  in  this  state. 

(G)  Evidence  that  the  applicant  is  receiving  public  assistance  other 
than  Medi-Cal  in  this  state. 

(H)  Evidence  that  the  applicant  has  registered  to  vote  in  this  state. 

(1)  Any  evidence  produced  in  accordance  with  subdivision  b. 

(2)  The  applicant  declares  under  penalty  of  perjury,  that  all  ofthe  fol- 
lowing apply: 

(A)  The  applicant  does  not  maintain  a  principal  residence  outside  this 
state.  When  an  applicant  is  unable  to  make  this  declaration  because  he  or 


Page  346.2 


Register  99,  No.  41;  10-8-99 


Title  22  Health  Care  Services  §  50320.1 

she  claims  an  out-of-state  principal  residence  as  exempt  property  under  ment  insurance  benefits. 

section  50425,  the  county  shall  consider  any  evidence  provided  by  the  (b)  If  an  applicant,  including  but  not  limited  to  homeless  persons  and 

applicant  pursuant  to  Section  50320.2(c).  migrant  workers,  declares  under  penalty  of  perjury,  that  he  or  she  does 

(B)  The  applicant  is  not  receiving  public  assistance  outside  this  state,  not  have  one  of  the  residency  verification  documents  required  in  Subdi- 

As  used  in  the  section,  "public  assistance"  does  not  include  unemploy-  vision  (a)(1)(A)  through  (a)(1)(H),  the  county  shall  consider,  pursuant  to 


[The  next  page  is  347.] 


Page  346.3  Register  99,  No.  41;  10-8-99 


Title  22 


Health  Care  Services 


§  50329 


Section  50320.2,  any  other  evidence  produced  by  an  applicant  to  verify 
residency  except  those  documents  specified  in  subdivision  50320.2(b). 
NOTE:  Authority  cited:  Sections  10725,  14007.1  and  14124.5,  Welfare  and  Insti- 
tutions Code.  Reference:  Section  66,  Chapter  722,  Statutes  of  1992;  and  42  Code 
of  Federal  Regulations  435.403. 

History 
1 .  New  section  filed  5-1 7-93  as  an  emergency  with  Secretary  of  State  by  the  De- 
partment of  Health  Services;  operative  5-17-93.  Submitted  to  OAL  for  printing 
only  pursuant  to  1992  Senate  Bill  485  (Register  93,  No.  21). 


§  50320.2.    California  Residency — County  Verification. 

(a)  The  county  may  request  clarification  of  the  applicant's  residency 
if  it  determines  that  any  information  provided  as  part  of  his  or  her  Medi- 
Cal  application  is  inconsistent  with  the  statement  on  the  MC  210  State- 
ment of  Facts  (Medi-Cal),  or  on  the  SAWS  2  Statement  of  Facts  that  the 
applicant  is  a  resident  of  California. 

(b)  A  declaration,  affidavit,  or  other  statement  from  the  applicant,  or 
any  other  person  that  the  applicant  is  a  resident  of  California  is  unaccept- 
able as  verification  of  residency  in  the  absence  of  other  credible  evidence 
that  supports  a  finding  that  the  applicant  is  a  resident  of  California  pur- 
suant to  Section  50320(b). 

(c)  When  an  applicant  claims  an  out-of-state  principal  residence  as 
exempt  property  under  Section  50425,  the  county  shall  determine  that 
such  an  applicant  is  a  resident  of  California  only  if  a  preponderance  of 
the  credible  evidence  provided  under  Section  50320.1  supports  a  finding 
that  the  applicant  is  a  resident  of  California  pursuant  to  Section  50320(b). 

(d)  A  migrant  worker  who  claims  to  be  a  resident  of  California  pur- 
suant to  Section  50320(b)(2)  shall  provide  evidence  that  he  or  she  entered 
the  state  with  a  job  commitment  or  evidence  that  he  or  she  entered  the 
state  to  seek  employment,  whether  or  not  currently  employed.  The 
county  shall  determine  that  such  an  applicant  is  a  resident  of  CaUfornia 
only  if  a  preponderance  of  the  credible  evidence  supports  a  finding  that 
the  applicant  is  a  resident  of  California  pursuant  to  Section  50320(b)(2). 

(e)  The  county  may  determine  that  the  claim  on  the  MC  210  Statement 
of  Facts  (Medi-Cal),  or  on  the  SAWS  2  Statement  of  Facts  is  supported, 
and  that  the  applicant  is  a  resident  of  California  if  a  preponderance  of  the 
credible  evidence  produced  by  the  applicant  supports  a  finding  that  the 
applicant  is  a  resident  of  California.  If  a  preponderance  of  the  credible 
evidence  produced  by  the  applicant  does  not  support  the  finding  that  the 
applicant  is  a  resident  of  California,  the  applicant  shall  be  determined  not 
to  be  a  resident  of  California,  shall  be  denied  eligibility  for  Medi-Cal 
benefits,  and  shall  be  afforded  all  notification  and  fair  hearing  rights  pro- 
vided to  any  person  denied  eligibility  for  Medi-Cal. 

(f)  A  denial  of  a  determination  of  residency  may  be  appealed  in  the 
same  manner  as  any  other  denial  of  eligibility.  The  Administrative  Law 
Judge  shall  receive  any  proof  of  residency  offered  by  the  applicant  and 
may  inquire  into  any  facts  relevant  to  the  question  of  residency.  A  deter- 
mination of  residency  shall  not  be  granted  unless  a  preponderance  of  the 
credible  evidence  supports  either  the  applicant's  intent  to  remain  indefi- 
nitely in  this  state,  or  any  other  basis  provided  by  the  laws  governing  the 
Medi-Cal  program  for  establishing  residency  for  Medi-Cal  eligibiUty. 
NOTE:  Authority  cited:  Sections  10725,  14007.1  and  14124.5,  Welfare  and  Insti- 
tutions Code.  Reference:  Section  66,  Chapter  722,  Statutes  of  1992;  and  42  Code 
of  Federal  Regulations  435.403. 

History 
1 .  New  section  filed  5-17-93  as  an  emergency  with  Secretary  of  State  by  the  De- 
partment of  Health  Services;  operative  5-17-93.  Submitted  to  OAL  for  printing 
only  pursuant  to  1992  Senate  Bill  485  (Register  93,  No.  21). 

§  50321 .    Temporary  Absence  from  the  State. 

(a)  Residence  shall  not  be  affected  by  temporary  absence  from  the 
State  for  periods  of  60  days  or  less.  An  absence  of  60  days  or  less  shall 
be  presumed  to  be  a  temporary  absence  unless  there  is  evidence  to  the 
contrary. 

(b)  An  apphcation,  restoration,  redetermination  or  reapplication  from 
an  applicant  or  beneficiary  who  is  temporarily  absent  from  the  State  for 
60  days  or  less  shall  be  accepted. 


Note:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  42  Code  of  Federal  Regulations  435.403. 

History 

1 .  New  Note  filed  5- 1 7-93  as  an  emergency  with  Secretary  of  State  by  the  Depart- 
ment of  Health  Services;  operative  5-17-93.  Submitted  to  OAL  for  printing 
only  pursuant  to  1992  Senate  Bill  485  (Register  93,  No.  21). 

§  50323.    Absence  from  the  State  for  More  Than  60  Days. 

(a)  Absence  from  the  State  for  more  than  60  days  shall  be  presumptive 
evidence  of  the  applicant's  or  beneficiary's  intent  to  change  residence 
from  California  to  a  place  outside  the  State  unless  the  person  declares  in 
writing  both: 

(1)  An  intent  to  return  to  California. 

(2)  The  existence  of  one  of  the  following  circumstances: 

(A)  Illness  or  emergency  circumstances  which  prohibit  return  to  Cali- 
fornia. 

(B)  Family  members  with  whom  the  applicant  or  beneficiary  lives  are 
California  residents  and  are  physically  present  in  the  State. 

(C)  The  applicant  or  beneficiary  maintains  California  housing  ar- 
rangements. 

(b)  Unless  there  is  evidence  to  the  contrary,  California  residence  may 
be  considered  to  be  terminated  when  an  applicant  or  beneficiary  leaves 
California  and  then  takes  any  of  the  following  actions  in  another  state: 

(1)  Purchases,  leases  or  rents  a  residence. 

(2)  Becomes  employed. 

(3)  Obtains  an  out-of-state  driver's  license. 

(4)  Applies  for  aid  in  another  state. 

(c)  Medi-Cal  shall  be  discontinued  effective  the  last  day  of  the  month 
in  which  residence  terminated,  if  the  10  day  notice  can  be  given.  Other- 
wise, the  discontinuance  shall  be  effective  the  last  day  of  the  following 
month. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 

Code.  Reference:  42  Code  of  Federal  Regulations  435.403. 

History 

1.  Amendment  of  subsection  (a)  and  new  Note  filed  5-17-93  as  an  emergency 
with  Secretary  of  State  by  the  Department  of  Health  Services;  operative 
5-17-93.  Submitted  to  OAL  for  printing  onlv  pursuant  to  1992  Senate  Bill  485 
(Register93,  No.  21). 

§  50325.    Death  During  Absence  from  the  State. 

A  person  who  dies  during  an  absence  from  the  State  shall  be  consid- 
ered a  resident  if  there  is  evidence  that  the  requirements  of  Section  50321 
or  Section  50323  were  met  at  the  time  of  death. 

NoTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  42  Code  of  Federal  Regulations  435.403. 

History 

1 .  New  Note  filed  5-17-93  as  an  emergency  with  Secretary  of  State  by  the  Depart- 
ment of  Health  Services;  operative  5-17-93.  Submitted  to  OAL  for  printing 
only  pursuant  to  1992  Senate  Bill  485  (Register  93,  No.  21). 

§  50327.     Persons  Living  on  Land  Leased  or  Owned  by  the 
United  States. 

Persons  living  within  the  boundaries  of  California  on  land  owned  or 
leased  by  the  Federal  Government  shall  be  considered  California  resi- 
dents. 

NotE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  42  Code  of  Federal  Regulations  435.403. 

History 
1 .  New  Note  filed  5-1 7-93  as  an  emergency  with  Secretary  of  State  by  the  Depart- 
ment of  Health  Services;  operative  5-17-93.  Submitted  to  OAL  for  printing 
only  pursuant  to  1992  Senate  Bill  485  (Register  93,  No.  21 ). 

§  50329.     Persons  on  Parole  from  Correctional  or  Other 
Institutions. 

Persons  on  parole  from  correctional  or  other  institutions  may  establish 

California  residence. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 

Code.  Reference:  42  Code  of  Federal  Regulafions  435.403. 

History 

1 .  New  Note  filed  5-17-93  as  an  emergency  with  Secretary  of  State  by  the  Depart- 
ment of  Health  Services;  operative  5-17-93.  Submitted  to  OAL  for  printing 
only  pursuant  to  1992  Senate  Bill  485  (Register  93,  No.  21 ). 


Page  347 


Register  97,  No.  50;  12-12-97 


§  50331 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


§  50331 .     United  States  Citizen  Children  of  Aliens. 

NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14007,  Welfare  and  Institutions  Code. 

History 

1 .  Repealer  filed  2-6-80  as  an  emergency;  effective  upon  filing.  A  Certificate  of 
Compliance  must  be  transmitted  to  OAH  within  120  days  or  emergency  lan- 
guage will  be  repealed  on  6-6-80  (Register  80,  No.  6). 

2.  Certificate  of  Compliance  filed  6-6-80  (Register  80,  No.  23). 

§  50333.    Foster  Children  and  Institutionalized  Persons 
Placed  Out-of-state. 

(a)  A  child  placed  in  out-of-state  foster  care  maintains  California  resi- 
dence if  the  child  was  placed  under  either  of  the  following: 

(1)  Through  the  Interstate  Compact  on  the  Placement  of  Children. 

(2)  By  a  state  or  county  agency  responsible  for  the  child's  care. 

(b)  A  person  placed  in  an  out-of-state  institution  by  a  state  or  county 
agency  responsible  for  the  person's  care  maintains  California  residence 
unless  the  other  state  accepts  responsibility  for  the  person. 

NOTE;  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14007,  Welfare  and  Institutions  Code. 

History 
1 .  Amendment  filed  10-23-81 ;  effective  thirtieth  day  thereafter  (Register  81 ,  No. 
43). 

§  50334.    Out-of-state  Foster  Children  and 

Institutionalized  Persons  Placed  in  California. 

(a)  An  out-of-state  child  placed  in  foster  care  in  California  is  a  Cali- 
fornia resident  if  both  of  the  following  conditions  are  met: 

(1)  The  child  was  placed  by  an  out-of-state  court  directly  with  a 
guardian  or  foster  parent  in  California. 

(2)  The  other  state  has  not  adopted  the  Interstate  Compact  on  the  Place- 
ment of  Children. 

(b)  An  out-of-state  person  placed  in  an  institution  in  California  by 
another  state  agency,  or  a  local  goveinment  agency  in  another  state,  re- 
sponsible for  the  person's  care  remains  a  resident  of  the  placing  state  un- 
less a  California  state  or  county  agency  accepts  responsibility  for  the  per- 
son. 

NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14007,  Welfare  and  InsUtutions  Code. 

History 
1 .  Amendment  filed  10-23-81 ;  effective  thirtieth  day  thereafter  (Register  81,  No. 

43). 

§  50336.    Other  Persons  in  Out-of-State  Institutions. 

(a)  The  Director  shall  have  the  authority  to  determine  the  state  of  resi- 
dence for  a  person  who  is  living  in  an  institution  in  another  state  when 
that  state's  medical  assistance  agency  claims  the  person  is  a  California 
resident. 

(b)  Applications  for  Medi-Cal  on  behalf  of  the  persons  specified  in  (a) 
shall  be  referred  to  the  Director  by  the  county  department. 

(c)  The  determination  shall  be  made  in  accordance  with  federal  Medic- 
aid regulation  42  CFR  435.403,  and  shall  be  based  upon  such  factors  as 
the  person's  age,  competency,  former  state  of  physical  presence,  the  resi- 
dence of  the  person's  parents  or  in  accordance  with  an  interstate  agree- 
ment entered  into  by  the  Director  and  another  state's  medical  assistance 
agency. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  InsUtutions 
Code.  Reference:  Section  14007,  Welfare  and  Institutions  Code. 

History 

1.  New  section  filed  10-23-81;  effective  thirtieth  day  thereafter  (Register  81,  No. 
43). 

2.  Amendment  of  subsection  (c)  filed  5-17-93  as  an  emergency  with  Secretary  of 
State  by  the  Department  of  Health  Services;  operative  5-17-93.  Submitted  to 
OAL  for  printing  only  pursuant  to  1992  Senate  Bill  485  (Register  93,  No.  21). 

§  50338.    Other  Persons  in  California  Institutions. 

(a)  Persons  living  in  California  institutions,  other  than  persons  speci- 
fied in  Section  50334  shall  be  considered  California  residents. 

(b)  Notwithstanding  (a),  the  Director  shall  have  the  authority  to  deter- 
mine the  state  of  residence  for  persons  in  California  institutions  in  accor- 
dance with  federal  Medicaid  regulation  42  CFR  435.403.  The  determina- 


tion shall  be  based  upon  such  factors  as  the  person's  age,  competency, 
fonner  state  of  physical  presence  and  the  residence  of  llie  person's  par- 
ents, or  in  accordance  with  an  interstate  agreeinent  entered  into  by  the  Di- 
rector and  another  state's  medical  assistance  agency.  The  county  depart- 
ment shall,  upon  request  by  the  Director,  obtain  the  information 
necessary  for  the  determination  to  be  made. 

NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14007,  Welfare  and  InsUtutions  Code. 

History 

1.  New  section  filed  10-23-81;  effective  thirtieth  day  thereafter  (Register  8 1,  No. 
43). 

2.  Amendment  of  subsection  (b)  filed  5-17-93  as  an  emergency  with  Secretary  of 
State  by  the  Department  of  Health  Services;  operative  5-17-93.  Submitted  to 
OAL  for  printing  only  pursuant  to  1992  Senate  Bill  485  (Register  93,  No.  21). 


Article  8. 


Responsible  Relatives  and  Unit 
Determination 


§  50351 .     Responsible  Relatives. 

(a)  The  responsibility  of  a  relative  to  contribute  to  the  cost  of  health 
care  services  of  a  Medi-Cal  applicant  or  beneficiary  shall  be  limited  to 
spouse  for  spouse  and  parent  for  child. 

(b)  In  determining  Medi-Cal  eligibility  and  share  of  cost,  relative  re- 
sponsibility shall  be  determined  in  accordance  with  the  following: 

(1 )  Relative  responsibility  shall  be  spouse  for  spouse  when  the  spouses 
are  living  together  in  the  home. 

(2)  If  one  or  both  of  the  spouses  is  in  LTC  or  board  and  care,  the 
spouses  income  and  property  shall  be  considered  available  in  determin- 
ing each  other's  eligibility  and  share  of  cost  in  accordance  with  the 
MFBU  composition  provision  of  Section  50377. 

(3)  If  neither  of  the  spouses  is  in  LTC  or  board  and  care  but  the  spouses 
are  living  apart,  the  spouses  shall  have  their  eligibility  and  share  of  cost 
determined  as  single  persons  the  day  following  the  separation,  if  it  is 
known  that  the  separation  will  not  be  temporary  in  accordance  with  Sec- 
tion 50071(b). 

(4)  Relative  responsibility  shall  be  parent  for  child  living  in  the  par- 
ent's home  and  persons  specified  in  (c),  except  that  the  parents  shall  nei- 
ther be  held  financially  responsible  for,  nor  asked  or  required  to  contrib- 
ute to,  or  provide  other  health  care  coverage  for,  the  cost  of  minor  consent 
services  which  the  child  applies  for  in  accordance  with  Section 
50147.1(a). 

(c)  Notwithstanding  Sections  50014  and  50030,  any  person  whether 
h  ving  in  the  home  or  away  from  the  home,  shall  be  considered  a  child  and 
his/her  parent  shall  be  considered  a  responsible  relative  when  both  of  the 
following  conditions  exist: 

(1)  The  person  is  18  years  of  age  or  older  but  under  21. 

(2)  The  parent  claims  the  child  as  a  dependent  in  order  to  receive  a  tax 
credit  or  deduction  for  state  or  federal  income  tax  purposes. 

(d)  Where,  under  Section  50373(a)(5),  deeming  occurs  that  is  not 
spouse  for  spouse  or  parent  for  child  as  required  under  subsection  (a),  and 
the  family  has  excess  properly  or  a  share  of  cost,  or  both,  the  county  shall 
redetermine  the  budget  unit  to  ensure  that  each  person's  available  income 
is  deemed  only  to  that  person's  child  or  spouse.  For  the  purposes  of  this 
subsection,  "deeming"  is  the  process  by  which  the  income  of  one  person 
is  treated  as  available  to  another  person. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  and  Section  87(c),  Chapter  1594,  Statutes  of  1982.  Reference:  Sections 
14008,  14008.6  and  14010,  Welfare  and  Insntutions  Code;  and  Sections  25.9  and 
34.7,  Civil  Code;  and  42  C.F.R.  Sections  433.135,  433.136,  433.137,  433.138, 
433.145,  433.146,  433.147,  433.148  and  435.604;  and  Sneed  v.  AT/zer  (N.D.  Cal 
1990)728F.  Supp.  607. 

History 

1 .  Amendment  filed  1-28-77  as  an  emergency;  effective  upon  filing  (Register  77, 

No.  5). 

2.  Certificate  of  Compliance  filed  4-22-77  (Register  77,  No.  17). 

3.  Amendment  of  subsections  (a)(2)(C)  and  (b),  and  repealer  of  subsection  (d)  filed 
10-31-78  as  an  emergency;  designated  effective  11-1-78  (Register  78,  No. 
44). 


Page  348 


Register  97,  No.  50;  12-12-97 


Title  22 


Health  Care  Services 


§  50373 


• 


4.  Certificate  of  Compliance  filed  2-6-78  (Register  79,  No.  6). 

5.  Amendment  filed  l-8-81;effectivethirtiethday  thereafter  (Register  81,  No.  2). 

6.  Amendment  of  subsection  (b)(4)  filed  4-28-82;  effective  thirtieth  day  thereaf- 
ter (Register  82,  No.  1 8). 

7.  Amendment  filed  10-1-82  as  an  emergency;  effective  upon  filing  (Register  82, 
No.  40).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  1-29-83. 

8.  Certificate  of  Compliance  transmitted  to  OAL  1-28-83  and  filed  2-28-83 
(Register  83,  No.  10). 

9.  Amendment  of  subsection  (c)(  1 )  filed  12-3-85;  effective  thirtieth  day  thereafter 
(Register  85,  No.  49). 

10.  Amendment  of  subsecfion  (b)(2)  and  Note  and  repealer  of  subsection  (d)  filed 
4-16-93  as  an  emergency;  operative  4-16-93  (Register  93,  No.  16).  A  Certifi- 
cate of  Compliance  must  be  transmitted  to  OAL  8-16-93  or  emergency  lan- 
guage will  be  repealed  by  operation  of  law  on  the  following  day. 

1 1 .  Certificate  of  Compliance  as  to  4-1 6-93  order  includins  amendment  of  Note 
transmitted  to  OAL  8-13-93  and  filed  9-23-93  (Register  93,  No.  39). 

12.  New  subsection  (d)  and  amendment  of  Note  filed  12-9-97;  operafive  1-8-98 
(Register  97,  No.  50). 

§  50371 .    Medi-Cal  Family  Budget  Unit. 

(a)  The  Medi-Cal  Family  Budget  Unit  (MFBU)  shall  be  the  basic  unit 
of  persons  considered  in  determining  a  person's  or  family's  eligibility 
and  share  of  cost.  The  MFBU  shall  be  established  in  accordance  with 
Sections  50373  through  50379.  Members  of  the  MFBU  may  be  excluded 
from  an  established  MFBU  in  accordance  with  Section  50381. 

(b)  Changes  in  the  MFBU  shall  be  reflected  in  the  share  of  cost  deter- 
mination within  the  time  frames  specified  in  Section  50565,  except  that 
the  changes  may  be  reflected  in  the  month  the  changes  are  reported  if  it 
is  to  the  beneficiary's  advantage.  Any  advantage  shall  be  explained  to  the 
beneficiary.  The  beneficiary  shall  determine  whether  the  change  shall  be 
reflected  in  the  month  it  is  reported. 

Note-.  Authority  cited;  Sections  10725  and  14124.5.  Welfare  and  Institutions 
Code.Reference:Sectionsl4005.5, 14005.7, 14008  and  14051,  Welfare  and  Insti- 
tutions Code. 


History 
1. Amendment  filed  1-28-77  as  an  emergency;  effecfive  upon  filing  (Register  77, 
No.  5). 

2.  Certificate  of  Compliance  filed  4-22-77  (Register  77,  No.  17). 

3.  Amendment  of  subsections  (e)  and  (f)  and  repealer  of  subsection  (i)  filed 
12-1 5-77;  effecfive  thirtieth  day  thereafter  (Register  77,  No.  51). 

4.  Amendment  filed  3-7-80;  effective  thirtieth  day  thereafter  (Register  80,  No.  9). 

5.  Amendment  filed  1  -8-81 ;  effective  thirtieth  day  thereafter  (Register  81 ,  No.  2). 

6.  Amendment  of  subsection  (a)  filed  4-17-89;  operative  5-17-89  (Resister  89, 
No.  48). 

§  50373.    Medi-Cal  Family  Budget  Unit  Determination,  No 
Family  Member  in  LTC  or  Board  and  Care. 

(a)  The  MFBU  for  a  family  with  no  family  member  in  LTC  or  board 
and  care  shall  be  determined  in  accordance  with  the  following: 

(1)  Family  members  who  are  PA  or  Other  PA  recipients,  except  for 
persons  eligible  for  four  month  or  nine  month  continuing  eligibility,  shall 
not  be  included  in  the  MFBU. 

(2)  All  family  members  living  in  the  home,  other  than  those  specified 
in  (1),  shall  be  included  in  the  MFBU  in  accordance  with  (5)  whether  or 
not  they  are  eligible  for,  or  wish  to  receive,  Medi-Cal.  Potential  members 
of  the  MFBU  may  be  excluded  in  accordance  with  Section  50381. 

(3)  All  family  members  living  in  the  home,  except  those  children  ex- 
cluded from  the  MFBU  in  accordance  with  50381  and  children  who  are 
ineligible  for  Medi-Cal,  shall  be  considered  in  determining  whether  link- 
age to  AFDC  exists.  Family  members  also  include  persons  who  are  PA 
or  other  PA  recipients. 

(4)  A  person  who  is  18  years  of  age  or  older,  but  under  age  21,  is 
claimed  as  a  dependent  in  order  to  receive  a  tax  credit  or  deduction  for 
state  or  federal  income  tax  purposes  shall  be  included  in  his/her  parent's 
MFBU. 

(5)  Once  the  potential  members  of  the  MFBU  have  been  identified,  the 
MFBU  shall  be  determined  in  accordance  with  the  following  as  modified 
by  Section  50374; 


Page  349 


Register  97,  No.  50;  12-12-97 


§  50373 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


(A)  Family  members  living  in 
the  home. 

1.  Individual  adult. 

2.  Individual,  spouse. 

3.  Parent,  children. 

4.  Both  unmarried  parents,  mu- 
tual children. 

5.  Both  unmarried  parents,  mu- 
tual children,  separate  children  of 
either  or  both  parents. 


6.  Parent,  spouse,  mutual  chil- 
dren. 

7.  Parent,  spouse,  mutual  chil- 
dren and/or  separate  child  of  either 
or  both  parents. 

8.  Minor  parent,  minor  parent's 
children,  the  minor  parent's  parent 
and  that  person's  spouse  and/or 
children. 


9.  Unmarried  minor  parent,  sec- 
ond unmarried  parent,  their  mutual 
children,  separate  children  of  either 
or  both,  unmarried  minor  parent's 
parent  and  that  person's  spouse 
and/or  children. 


10.  Married  minor  parent,  minor 
parent's  spouse,  their  mutual  chil- 
dren, separate  children  of  either  or 
both,  minor  parent' s  parent  and  that 
person's  spouse  and/or  children. 


(B)  MFBU 


1.  Individual  adult. 

2.  Individual,  spouse. 

3.  Parent,  children. 

4.  Both  unmarried  parents, 
mutual  children. 

5.  Both  unmarried  parents, 
mutual  children,  separate 
children,  except  that  when  all 
the  mutual  children  are  ex- 
cluded in  accordance  with 
Section  50381,  each  unmar- 
ried parent  and  that  parent's 
separate  children  shall  be  in  a 
separate  MFBU. 

6.  Parent,  spouse,  mutual 
children. 

7.  Parent,  spouse,  mutual 
cMldren,  separate  children  or 
the  parent  and  the  separate 
children  of  that  parent  if  the 
conditions  of  50375  are  met. 

8.  Two  MFBU' s: 

a.  Minor  parent  as  an  ineli- 
gible member,  minor  parent's 
children. 

b.  Minor  parent,  the  minor 
parent's  parent  and  that  per- 
son's spouse  and/or  children 
(MFBU  is  determined  in  ac- 
cordance with  (3)  through 
(7)). 

Q.TwoMFBU's: 

a.  Unmarried  minor  parent 
as  an  ineligible  member,  sec- 
ond unmarried  parent,  sepa- 
rate children  of  either  unmar- 
ried parents,  mutual  children. 

b.  Unmarried  minor  parent, 
the  unmarried  minor  parent's, 
parent(s)  and  his/her  spouse 
and/or  children  (MFBU  is  de- 
termined in  accordance  with 
(3)  through  (7)). 

10.  Three  MFBU' s: 

a.  Married  minor  parent; 
married  minor  parent' s  spouse 
and  children  as  ineligible 
members,  and  married  minor 
parent's  parent  and  that  per- 
son's spouse  as  ineligible 
member(s). 

b.  Married  minor  parent  as 
an  ineligible  member,  married 
child's  spouse  and  children. 

c.  Married  minor  parent  as 
an  ineligible  member,  married 
minor's  parent  and  that  per- 
son's spouse  and/or  children. 


1 1 .  Child  living  with  the  child's 
parents  requesting  Medi-Cal  for 
minor  consent  services,  whose 
application  is  being  processed  in 
accordance  with  Section 
501 47. 1  (d)  (3)  (D),  the  child's  chil- 
dren. 

12.  Sibling  children  if  all  other 
family  members  are  PA  or  Other 
PA. 

13.  Parent,  spouse  if  all  children 
are  PA  or  other  PA. 

14.  Sibling  children,  caretaker 
relative. 


15.  Caretaker  relative  if  all  chil- 
dren are  PA  or  other  PA. 

16.  Sibhng  children,  caretaker 
relative,  caretaker  relative's  spouse 
and/or  children. 


17.  Caretaker;  sibhng  children; 
caretaker's  spouse.  (Spouse  does 
not  want  Medi-Cal  or  is  not  eligi- 
ble). 

18.  Caretaker;  sibling  children; 
caretaker's  spouse;  their  own 
children.  (Spouse  has  no  linkage. 
Caretaker  has  linkage  only  as  a 
caretaker  relative. 

19.  Caretaker;  sibling  children; 
other  related  sibling  children. 


11.   Child 
children. 


and   the  child's 


20.  Caretaker;  sibling  children; 
caretaker's  spouse  is  PA.  (Care- 
taker has  linkage  only  as  a  care- 
taker relative). 

21.  Caretaker;  sibling  children 
are  PA;  caretaker's  spouse;  their 
own  children.  (Caretaker  has  link- 
age only  as  a  caretaker  relative  or 
chooses  to  be  linked  to  related 
children  other  than  his/her  own). 

22.  Caretaker;  sibling  children; 
caretaker's  spouse  is  PA;  their 
own  children.  (Caretaker  has  Unk- 
age  only  as  a  caretaker  relative  or 
chooses  to  be  linked  to  related 
children  other  that  his/her  own). 


12.  Sibling  children. 


13.  Parent,  spouse. 

14.  Sibling  children  and  care- 
taker relative,  when  the  caretak- 
er relative  chooses  to  be  in- 
cluded. 

15.  Caretaker  relative. 

16.  Two  MFBU' s: 

a.  Sibhng  children. 

b.  Caretaker  relative  and  his/ 
her  spouse  and/or  children 
(MFBU  is  determined  in  accor- 
dance with  (3)  through  (7)). 

17.  Caretaker;  sibling  chil- 
dren. 


18.  TwoMFBU's: 

a.  Caretaker;  sibling  children. 

b.  Caretaker  and  caretaker's 
spouse  as  ineligible;  their 
own  children. 

19.  TwoMFBU's: 

a.  Sibling  children. 
(Caretaker  has  linkage  only  as 

a  caretaker  relative). 

b.  Other  sibling  children; 
Caretaker 

or 

c.  Sibling  children;  caretaker, 
d.  Other  sibling  children. 

20.  Caretaker;  sibling  children. 


21.  TwoMFBU's: 

a.  Caretaker. 

b.  Caretaker  as  ineligible; 
spouse;  his/her  own  children. 

22.  Two  MFBU's: 

a.  Caretaker;   sibhng  chil- 
dren. 

b.  Caretaker   as   ineligible 
member;  his/her  own  children. 


Page  350 


Register  97,  No.  50;  12-12-97 


Title  22 


Health  Care  Services 


§  50375 


• 


(C)  Family  members,  not  liv- 
ing in  the  home. 

1.  Person  18  to  21  when  the 
person  is  claimed  by  his/her  par- 
ent(s)  as  a  dependent  in  order  to 
receive  a  tax  credit  or  deduction 
for  state  or  federal  income  taxa- 
tion. 

2.  Person  18  to  21,  person's 
spouse  and  children,  and  person's 
parent(s)  when  the  person  is 
claimed  by  his/her  parent(s)  as  a 
dependent  in  order  to  receive  a  tax 
credit  or  deduction  for  state  or 
federal  income  taxation. 


3.  Child  in  foster  care. 

4.  Sibling  children  in  foster 
care. 


(D)  MFBU 

1 .  Person  and  parents  in  ac- 
cordance with  (A). 


2.  Three  MFBU' s. 

a.  Person  claimed  as  a  tax 
dependent;  person's  spouse 
and  children  as  ineligible 
members,  and  person's  par- 
ent(s)  as  ineligible  mem- 
bers(s). 

b.  Person  claimed  as  a  tax 
dependent  as  an  ineligible 
member,  person's  spouse  and 
children. 

c.  Person  claimed  as  a  tax 
dependent  as  an  ineligible 
member,  person's  parent(s). 

3.  Child. 

4.  Each  sibling  child  is  in 
his/her  own  MFBU  even  if 
placed  in  the  same  foster 
home. 

5.  Child. 


• 


5.  Child  detained  or  place  by  a 
court  or  court  designated  agency 
under  Welfare  and  Institutions 

Code  Sections  300  or  601.  6.  Child. 

6.  Child  not  living  with  a  parent 
or  relative  for  whom  a  pubhc 
agency  is  assuming  financial  re- 
sponsibility in  whole  or  in  part.  7.  Child. 

7.  Child  not  living  with  a  parent 
or  caretaker  relative  when  parents 
or  public  agencies  have  been  con- 
tacted to  determine  whether  they 
will  accept  legal  responsibility  for 
the  child. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4, 14005.7, 14005.8, 14008  and  14010,  Welfare 
and  Institutions  Code. 

History 

1.  Amendment  of  subsections  (a)(1)  and  (a)  (4)  filed  4-15-83  as  an  emergency; 
effective  upon  filing  (Register  85,  No.  16).  A  Certificate  of  Compliance  must 
be  transmitted  to  OAL  within  120  days  or  emergency  language  will  be  repealed 
on  8-1 3-85.  For  prior  history,  see  Register  83,  No.  21 . 

2.  Certificate  of  Compliance  transmitted  to  OAL,  8-13-85  and  filed  9-18-85 
(Register  85,  No.  38). 

3.  Amendment  of  subsection  (a)(4)  filed  12-3-85;  effective  thirtieth  day  thereafter 
(Register  85,  No.  49). 

4.  Change  without  regulatory  effect  of  subsections  (a)(2)  and  (a)(5)  (A)  10.  (Regis- 
ter 87,  No.  11). 

5.  Amendment  of  subsection  (a)(3)  filed  6-3-87;  operative  7-3-87  (Register  87, 
No.  47).  Ed.  Note:  The  changes  to  the  text  of  subsection  (a)(3)  were  printed  in 
Register  87,  No.  24;  however,  the  HISTORY  NOTE  was  inadvertently  omitted. 

6.  Amendment  of  subsecfion  (a)(5)  filed  4-17-89;  operafive  5-17-89  (Register 
89,  No.  48). 

7.  Editorial  correction  of  printing  error  in  subsection  (a)(5)(B)9.  (Register  93,  No. 
13). 

8.  Amendment  of  secfion  and  Note  filed  12-9-97;  operative  1  -8-98  (Register  97, 
No.  50). 

§  50374.    MFBU  Determination— Child  Stays  Alternately 
with  Each  Parent. 

(a)  A  child,  who  stays  alternately  for  periods  of  one  month  or  less  with 
each  of  his/her  parents  and  the  parents  are  separated  or  divorced,  shall  be 


included  in  the  MFBU  of  the  parent  specified  in  this  section.  The  child 
shall  be  included  in  the  MFBU  of  the  parent: 

(1)  With  whom  the  child  stays  for  the  majority  of  time  unless  the  other 
parent  can  establish  that  he/she  has  majority  responsibility,  as  defined  in 
(c),  or  care  and  control  of  the  child. 

(2)  Who  has  majority  responsibility,  as  defined  in  (c),  when  the  child 
spends  an  equal  amount  of  time  with  each  parent. 

(3)  Who  applies  for  Medi-Cal  on  behalf  of  the  child,  when  the  child 
spends  an  equal  amount  of  time  with  each  parent  and  each  parent  exer- 
cises an  equal  share  of  care  and  control  responsibilities.  When  both  par- 
ents apply  for  Medi-Cal  for  such  a  child,  the  child's  MFBU  shall  be  de- 
termined in  accordance  with  (b). 

(b)  A  child  described  in  (a)  (3)  shall  be  included  in  the  MFBU  of  the 
parent  who  solely  meets  one  of  the  following  conditions  in  the  order  spe- 
cified. The  parent  who: 

( 1 )  Is  designated  in  a  current  court  order  as  the  primary  parent  for  pur- 
poses of  public  assistance,  under  Civil  Code,  Section  4600.5(h). 

(2)  Is  eligible  for  Medi-Cal. 

(3)  Is  designated,  through  mutual  agreement  of  both  parents,  as  the  pri- 
mary parent  for  purposes  of  public  assistance. 

(4)  First  applied  for  Medi-Cal  on  behalf  of  the  child. 

(c)  For  purposes  of  this  section,  when  determining  which  parent  has 
majority  responsibility  for  care  of  a  child,  the  following  factors  shall  be 
considered.  In  addition,  other  similar  factors  shall  also  be  considered  as 
a  single  factor  may  not  be  determinative.  The  determination  shall  in- 
clude, the  extent  to  which  the  parent: 

(1)  Decides  where  the  child  attends  school. 

(2)  Deals  with  the  school  on  educational  decisions  and  problems. 

(3)  Controls  participation  in  extracurricular  and  recreational  activities. 

(4)  Arranges  medical  and  dental  care  services. 

(5)  Claims  the  child  as  a  tax  dependent. 

(6)  Purchases  and  maintains  the  child's  clothing. 

(d)  Once  the  MFBU  has  been  determined  with  (a),  (b)  and  (c),  the  child 
shall  remain  in  that  MFBU  while  staying  with  the  other  parent  for  alter- 
nating periods  of  one  month  or  less.  If  the  child  stays  with  the  other  parent 
consecutively  for  more  than  one  month,  then  the  child  shall  be  included 
in  the  MFBU  of  that  parent. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Secfions  14005.7,  14008  and  14051,  Welfare  and  Insfitutions 
Code. 

History 
1.  New  secfion  filed  4-17-89;  operafive  5-17-89  (Register  89,  No.  48). 

§  50375.    Medi-Cal  Family  Budget  Unit  Determination, 
Stepparent  Cases. 

(a)  Family  members  in  a  family  which  includes  a  stepparent  shall  be 
in  the  same  MFBU  unless  only  the  separate  children  of  one  parent  wish 
to  receive  Medi-Cal. 

(b)  If  the  applicant  requests  that  only  the  separate  children  of  one  par- 
ent receive  Medi-Cal,  the  right  to  make  this  choice  and  its  effects  shall 
be  explained  to  the  applicant  at  the  time  of  the  face-to-face  interview. 

(c)  The  stepparent  unit  shall  consist  of  the  following: 

(1)  Stepparent. 

(2)  Parent. 

(3)  Mutual  children. 

(4)  Stepparent's  separate  children. 

(d)  When  only  the  separate  children  of  one  parent  will  receive  Medi- 
Cal: 

(1)  The  parent  of  the  separate  children  shall  be  an  ineligible  member 
of  the  separate  children's  MFBU  in  accordance  with  Section  50379(e). 

(2)  The  members  of  the  stepparent  unit,  other  than  the  parent  of  the 

separate  children  shall  be  excluded  from  the  MFBU  in  accordance  with 

Section  50381(b). 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Secfions  14005.4,  14005.7,  14008,  14051  and  14052,  Welfare 
and  Institutions  Code. 


Page  350.1 


Register  97,  No.  50;  12-12-97 


§  50377 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


History 

1.  New  section  filed  l-8-81;effective  thirtieth  day  thereafter  (Register  81,  No.  2). 

2.  Amendment  of  subsection  (c)  filed  2-1 1-82;  effective  thirtieth  day  thereafter 
(Register  82,  No.  7). 

3.  Amendment  of  subsection  (a)(3)  filed  6-3-87;  operative  7-3-87  (Register  87, 

No.  24). 

4.  Amendment  filed  12-9-97;  operative  1-8-98  (Register  97,  No.  30). 


§  50377.    Medi-Cal  Family  Budget  Unit  (MFBU) 

Determination,  Family  Member  in  Long-Term 
Care  or  Board  and  Care. 

(a)  An  aged,  blind  or  disabled  person  who  is  in  LTC  or  board  and  care 
shall  be  in  his/her  own  MFBU,  except  as  provided  in  (c). 

(b)  An  aged,  blind  or  disabled  person's  spouse  who  is  in  LTC  or  board 
and  care  shall  be  in  his/her  own  MFBU,  except  as  provided  in  (c). 

(c)  Spouses  and  their  children  shall  be  in  the  same  MFB  for  property 
evaluations  until  the  end  of  the  sixth  full  month  of  LTC  or  board  and  care 
status  when  all  of  the  following  conditions  are  met: 

(1)  Both  spouses  are  aged,  Wind  or  disabled. 

(2)  One  or  both  spouses  is  in  LTC  or  board  and  care. 

(3)  Both  spouses  apply  for  and  are  eligible  for  Medi-Cal. 

(d)  A  person  who  is  in  LTC  or  board  and  care  who  is  not  aged,  blind 
or  disabled  and  whose  spouse  is  not  aged,  blind  or  disabled  shall  be  in- 
cluded in  the  MFBU  with  the  person's  spouse,  and/or  children  or,  where 
the  person  is  a  child,  with  the  child's  parents. 

(e)  A  child  who  is  a  ward  of  the  court  or  the  responsibility  of  a  public 
agency  due  to  a  voluntary  placement  by  a  parent  or  guardian  and  who  is 
a  patient  in  a  medical  facility  shall  be  in  the  child's  own  MFBU. 

(f)  A  child  who  is  not  blind  or  disabled,  who  is  in  LTC  and  who  was 
not  living  with  the  child's  parents  immediately  prior  to  entering  LTC 
shall  be  in  the  child's  own  MFBU. 

(g)  Income  and  property  available  to  the  MFBUs  established  in  accor- 
dance with  this  section  shall  be  determined  in  accordance  with  Sections 
50557  and  50403. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code:  and  Section  5,  Chapter  1221,  Statutes  of  1985.  Reference:  Sections  14005.4, 
14005.7,  14005.16  and  14008,  Welfare  and  Institutions  Code. 

History 

1 .  New  section  filed  1-8-81 ;  effective  thirtieth  day  thereafter  (Register  81 ,  No.  2). 

2.  Amendment  filed  12-2-85  as  an  emergency;  effective  upon  filing  (Register  85, 
No.  50).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  4-1-86. 

3.  Amendment  refiled  3-28-86  as  an  emergency;  effective  upon  filing  (Register 
86,No.  13).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  7-28-86. 

4.  Certificate  of  Compliance  as  to  3-28-86  order  filed  6-6-86  (Register  86,  No. 

23). 

§  50379.    Ineligible  Members  of  the  Medi-Cal  Family 
Budget  Unit. 

(a)  Persons  who  are  ineligible  for  Medi-Cal  for  any  of  the  following 
reasons  shall  be  ineligible  members  of  the  MFBU,  as  limited  by  (b). 

(1)  Refusal  to  apply  for  a  Social  Security  number  except  as  specified 
in  Section  50302(c). 

(2)  Refusal  to  apply  for  a  Medicare  health  insurance  claim  number. 

(3)  Refusal  to  apply  for  and  accept  unconditionally  available  income. 

(4)  Inability  to  meet  the  basic  eligibility  criteria  for  any  of  the  Medi- 
Cal  programs. 

(5)  Parents  who  reside  outside  the  state  and  who  claim  their  children 
residing  in  the  state  as  dependents  in  order  to  receive  a  tax  credit  or  de- 
duction for  state  or  federal  income  tax  purposes. 

(6)  Refusal  by  a  parent  or  caretaker  relative  to  assign  to  the  state  all 
rights  to  medical  support  and  payments  for  medical  care  from  any  third 
party. 

(7)  Refusal  by  a  parent  or  caretaker  relative,  without  good  cause  as 
specified  in  Section  50771.5,  to  cooperate  in  establishing  paternity  for  a 
child  under  eighteen  years  of  age  bom  out  of  wedlock  for  whom  Medi- 


Cal  is  requested  and  in  obtaining  medical  support  and  payments,  and  in 
identifying  and  providing  information  concerning  any  third  party  who  is 
or  may  be  liable  to  pay  for  medical  care  or  support. 

(b)  A  child  ineligible  for  Medi-Cal  for  any  of  the  reasons  hsted  in  (a) 
who  has  separate  income  or  property  may  be  treated  as  an  ineligible 
member  of  the  MFBU  or  be  excluded  from  the  MFBU  in  accordance  with 
Section  50381.  This  choice  is  the  option  of  the  person  who  has  legal  re- 
sponsibiUty  for  the  child. 

(c)  Persons  who  are  eligible  for  four  month  continuing  eligibility  or 
Transitional  Medi-Cal  shall  be  ineligible  members  of  the  MFBU. 

(d)  Minor  parents  living  with  their  parents  shall  be  ineligible  members 
of  the  MFBU  that  includes  the  minor  parent's  cliildren  except  when  the 
minor  parent  wishes  to  receive  only  minor  consent  services.  Minor  par- 
ents who  wish  to  receive  Medi-Cal,  other  than  minor  consent  services, 
shall  be  included  in  the  MFBU  with  their  parents. 

(e)  The  parent  of  the  separate  children  in  a  stepparent  case  who  are  the 
only  family  members  who  wish  to  receive  Medi-Cal  in  accordance  with 
Section  50375  shall  be  an  ineligible  member  of  the  separate  children's 
MFBU. 

(f)  The  following  persons  shall  be  ineligible  members  of  the  MFBU 
when  a  person  1 8  to  21  is  claimed  by  his/her  parent  as  a  dependent  in  or- 
der to  receive  a  tax  credit  or  deduction  for  state  or  federal  income  taxa- 
tion: 

(1)  The  spouse,  children,  and  parent(s)  of  the  person  1 8  to  21  claimed 
as  a  tax  dependent  shall  be  ineligible  members  of  the  MFBU  which  in- 
cludes the  tax  dependent. 

(2)  The  person  18  to  21  claimed  as  a  tax  dependent  shall  be  an  ineligble 
member  of  the  MFBUs  which  include  either: 

(A)  His/her  parent(s). 

(B)  His/her  spouse  and  children. 

(g)  Ineligible  members  of  a  MFBU  shall: 

(1)  Be  included  in  the  MFBU  for  the  purpose  of  determining  eligibility 
based  on  property  and  share  of  cost. 

(2)  Have  their  health  care  costs  used  to  meet  the  share  of  cost. 

(3)  Not  be  issued  a  Medi-Cal  card. 

Note:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code;  Section  87(c),  Chapter  1594,  Statutes  of  1982;  and  Section  14,  Chapter 
1447,  Statutes  of  1984.  Reference:  Sections  14005.4, 14005.7, 14005.8, 14005.12, 
14007.1,  14008  and  14008.6,  Welfare  and  Insfitufions  Code;  Title  42,  Section 
1 396r-6,  UNited  States  Code;  and  42  C.F.R.  Secfions  433. 1 35. 433. 1 36, 433. 1 37, 
433.138,  433.145,  433.146,  433.147,  433.148  and  435.604. 

History 

1 .  New  section  filed  1  -8-8 1 ;  effective  thirtieth  day  thereafter  (Register  8 1 ,  No.  2). 

2.  New  subsecfions  (a)(5)-(6),  filed  10-1-82  as  an  emergency;  effective  upon  fil- 
ing (Register  82,  No.  40).  A  Certificate  of  Compliance  must  be  transmitted  to 
OAL  within  120  days  or  emergency  language  will  be  repealed  on  1-29-83. 

3.  Relettering  of  subsection  (0  to  subsection  (g)  and  new  subsection  (f)  filed 
12-21-82  as  an  emergency;  effecfive  upon  filing  (Register  82,  No.  52).  A  Cer- 
tificate of  Compliance  must  be  transmitted  to  OAL  within  120  days  or  emergen- 
cy language  will  be  repealed  on  4-20-83. 

4.  Amendment  of  subsection  (a)(5)  filed  12-31-82  as  an  emergency;  effective 
upon  filing  (Register  83,  No.  2).  A  Certificate  of  Compliance  must  be  trans- 
mitted to  OAL  within  120  days  or  emergency  language  will  be  repealed  on 
4-30-83. 

5.  Certificate  of  Compliance  as  to  10-1-82  order  transmitted  to  OAL  1  -28-83  and 
filed  2-28-83  (Register  83,  No.  10). 

6.  Certificate  of  Compliance  as  to  12-21-82  order  transmitted  to  OAL  4-19-83 
and  filed  5-16-83  (Register  83,  No.  21). 

7.  Certificate  of  Compliance  as  to  12-31-82  order  transmitted  to  OAL  4-13-83 
and  filed  5-16-83  (Register  83,  No.  21). 

8.  Amendment  of  subsections  (c)  and  (g)(2)  filed  4-1 5-85  as  an  emergency;  effec- 
five upon  fifing  (Register  85,  No.  16).  A  Certificate  of  Compliance  must  be 
transmitted  to  OAL  within  120  days  or  emergency  language  will  be  repealed  on 
8-13-85. 

9.  Certificate  of  Compliance  including  amendment  of  subsection  (g)(2)  trans- 
mitted to  OAL  8-13-85  and  filed  9-18-85  (Register  85,  No.  38). 

10.  New  subsecfions  (a)(7)  and  (a)(8)  and  amendment  of  Note;  filed  4-16-93  as 
an  emergency;  operafive  4-16-93  (Register  93,  No.  16).  A  Certificate  of  Com- 
pliance must  be  transmitted  to  OAL  8-16-93  or  emergency  language  will  be  re- 
pealed by  operation  of  law  on  the  following  day. 


• 


Page  350.2 


Register  97,  No.  50;  12-12-97 


Title  22 


Health  Care  Services 


§  50404 


1 1 .  Certificate  of  Compliance  as  to  4- 1 6-93  order  including  amendment  of  Note 
transmitted  to  OAL  8-13-93  and  filed  9-23-93  (Register  93,  No.  39). 

12.  Amendment  of  section  and  Note  filed  12-9-97;  operative  1-8-98  (Register 
97,  No.  50). 

§  50381 .    Persons  Excluded  from  the  Medi-Cal  Family 
Budget  Unit. 

(a)  Any  child,  other  than  an  unborn  or  an  infant  during  the  first  two 
months  of  life,  may  be  excluded  from  the  MFBU.  This  choice  shall  be  the 
option  of  the  person  who  has  legal  responsibility  for  the  child.  Excluded 
children  shall  not: 

(1)  Apply  separately  unless  they  apply  for  minor  consent  services. 

(2)  Be  included  in  the  MFBU  for  the  purpose  of  determining  eligibility 
and  share  of  cost. 

(3)  Be  considered  in  determining  the  program  for  which  the  persons 
included  in  the  MFBU  are  eligible. 

(4)  Have  their  health  care  costs  used  to  meet  the  MFBU's  share  of  cost. 

(b)  All  the  members  of  the  stepparent  unit  established  in  accordance 
with  Section  50375,  other  than  the  parent  of  the  separate  children  receiv- 
ing Medi-Cal,  shall  be  considered  excluded  from  the  MFBU.  The  ex- 
cluded members  shall  not: 

(1)  Apply  separately  unless  they  apply  for  minor  consent  services. 

(2)  Be  included  in  the  MFBU  for  the  purpose  of  determining  eligibility 
and  share  of  cost. 

(3)  Have  their  health  care  costs  used  to  meet  the  MFBU's  share  of  cost. 

(c)  The  county  department  shall  explain  to  the  applicant  who  has  a 
choice  of  being  included  or  excluded  from  the  MFBU  the  advantages  and 
disadvantages  of  such  an  action  before  the  choice  is  made. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4,  14005.7  and  14008,  Welfare  and  Institutions 
Code. 

History 

1.  New  section  filed  1-8-81 ;  effective  thirtieth  day  thereafter  (Register  81,  No.  2). 

2.  Amendment  of  subsections  (a),  (a)(4)  and  (b)(3)  filed  12-9-97;  operative 
1-8-98  (Register  97,  No.  50). 


Article  9.     Property 

§  50401 .    Property  Evaluation. 

(a)  After  determining  the  appropriate  Medi-Cal  program  for  the  mem- 
bers of  the  MFBU,  the  county  department  shall  evaluate  the  property 
holdings  of  the  MFBU  to  determine: 

(1)  Property  to  be  included  in  determining  eligibility. 

(2)  The  value  of  the  included  property. 

(3)  Whether  the  total  value  of  the  included  property  exceeds  the  prop- 
erty reserve  limits  specified  in  Section  50420. 

(b)  After  determining  the  value  of  all  property  to  be  included  in  the 
property  reserve  of  the  MFBU,  the  value  shall  be  waived  for  a  pregnant 
woman  and/or  infant  if  those  applicants  or  beneficiaries  are  found  to  be 
eUgible  under  the  200  Percent  program  as  provided  in  Section  50262(a). 

(c)  When  determining  eligibility  under  the  Percent  programs,  as  de- 
scribed under  Sections  50262.5  and  50262.6,  property  shall  be  disre- 
garded. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14006, 14148.5  and  14 148.75,  Welfare  and  Institutions 
Code. 

History 

1.  Editorial  correction  adding  Note  filed  6-10-83  (Register  83,  No.  24). 

2.  New  subsection  (b)  and  amendment  of  Note  filed  5-28-92  as  an  emergency; 
operative  5-28-92  (Register  92,  No.  22).  A  Certificate  of  Compliance  must  be 
transmitted  to  OAL  9-25-92  or  emergency  language  will  be  repealed  by  opera- 
tion of  law  on  the  following  day. 

3.  Certificate  of  Compliance  as  to  5-28-92  order  transmitted  to  OAL  9-25-92  and 
filed  10-19-92  (Register  92,  No.  43). 

4.  New  subsection  (c)  and  amendment  of  Note  filed  4-2-98  as  an  emergency;  op- 
erative 4-2-98.  SubmJtted  to  OAL  for  printing  only  pursuant  to  Welfare  and  In- 
stitutions Code  section  14148.75  (Register  98,  No.  16).  A  Certificate  of  Com- 
pliance must  be  transmitted  to  OAL  by  9-29-98  or  emergency  language  will  be 
repealed  by  operation  of  law  on  the  following  day. 


5.  Editorial  coixection  of  History  4  (Register  98,  No.  47). 

6.  Reinstatement  of  section  as  it  existed  prior  to  4-2-98  emergency  amendment 
by  operation  of  Government  Code  section  1 1346.1(f)  (Register  98,  No.  47). 

7.  New  subsection  (c)  and  amendment  of  NOTE  filed  11-18-98;  operative 
11-1 8-98  (Register  98,  No.  47). 


§  50402.    Availability  of  Property. 

Property  which  is  not  available  shall  not  be  considered  in  determining 
eligibility. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institufions 
Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 
1.  Chanse  without  regulatory  effect  adding  NOTE  filed  10-1 1-88  (Register  88, 

No.  45). 

§  50403.    Treatment  of  Property:  Separate  and  Community 
Property. 

(a)  The  separate  property  and  share  of  community  property  of  any  per- 
son included  in  the  MFBU  shall  be  considered  in  determining  Medi-Cal 
eligibility. 

(b)  A  spouse's  share  of  community  property  is  always  one-half  of  the 
current  total  community  property. 

(c)  For  purposes  of  establishing  eligibility,  an  interspousal  agreement 
entered  into  pursuant  to  Welfare  and  Institutions  Code  Section  14006.2 
shall: 

(1)  be  written,  dated  and  signed  by  both  spouses  or  by  a  person  who 
has  the  legal  authority  to  enter  into  such  agreements  on  behalf  of  either 
spouse; 

(2)  list  each  asset  being  transmuted; 

(3)  clearly  designate  the  owner  of  each  asset; 

(4)  list  the  value  of  each  asset;  and 

(5)  evidence  an  equal  division  of  the  nonexempt  community  property. 

(d)  If  an  interspousal  agreement  does  not  comply  with  (c)(4)  of  this 
section,  the  county  shall  request  additional  information  from  the  appli- 
cant, or  other  party  mentioned  in  (c)(1)  to  supplement  the  agreement  and 
verify  the  methodology  used  to  value  assets.  Such  information  may  be 
necessary  pursuant  to  verification  requirements  contained  in  Article  4  of 
this  Division. 

(e)  If  an  interspousal  agreement  evidences  an  unequal  division  of  the 
nonexempt  community  property,  and  the  applicant  received  the  smaller 
share  of  such  property  under  the  agreement,  the  county  shall  determine 
whether  the  transfer  was  for  adequate  consideration  in  accordance  with 
Sections  50408  and  50409. 

(1)  If  the  county  determines  that  the  transfer  was  not  for  adequate  con- 
sideration and  was  made  in  order  to  establish  eligibility  or  to  reduce  the 
share  of  cost,  the  county  shall  give  the  applicant's  spouse  the  option  of 
reconveying  to  the  applicant  in  accordance  with  Section  5041 1(d)(1)  an 
amount  of  property  sufficient  to  provide  each  spouse  with  equal  shares 
of  the  total  nonexempt  community  property  identified  in  the  interspousal 
agreement. 

(2)  If  the  applicant's  spouse  does  not  reconvey  property  pursuant  to 
(e)(  1)  above,  the  county  shall  assess  a  period  of  ineligibility  for  the  appli- 
cant in  accordance  with  Section  50411. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14006,  14006.2,  14008,  14008.5  and  14015,  Welfare 
and  Institutions  Code. 

History 

1 .  Amendment  filed  1  -8-8 1 ;  effective  thirtieth  day  thereafter  (Register  8 1 ,  No.  2). 

2.  New  subsections  (c),  (d)  and  (e)  filed  1 1-16-88;  operative  11-16-88  pursuant 
to  Government  Code  Section  11346.2(d)  (Register  88,  No.  49). 

§  50404.    Owner  of  Property. 

(a)  The  owner  of  property,  for  Medi-Cal  eligibility  purposes,  shall  be 
the  person  who  holds  legal  title  to  the  property  unless  otherwise  specified 
in  these  regulations. 

(b)  Ownership  of  property  may  be  vested  in  one  individual  or  shared 
with  other  individuals. 


Page  350.3 


Register  98,  No.  47;  11-20-S 


§  50405 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


(c)  Notwithstanding  (a),  a  person  shall  be  the  owner  of  separate  prop- 
erty designated  in  a  written  interspousal  agreement. 
NOTE:  Authority  cited:  Sections  10723  and  J4124.5.  Welfare  and  Institutions 
Code.  Reference:  Sections  14006  and  14006.2,  Welfare  and  institutions  Code. 

History 

1.  New  subsection  (c)  fded  2-16-88  as  an  emergency;  operative  2-16-88  (Regis- 
ter 88,  No.  10).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within 
120  days  or  emergency  language  will  be  repealed  on  6-13-88. 

2.  New  subsection  (c)refiled  6-16-88  as  an  emergency;  operative  6-16-88  (Reg- 
ister 88,  No.  26).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  with- 
in 120  days  or  emergency  language  will  be  repealed  on  10-14-88. 

3.  Emergency  language  of  new  subsection  (c)  refiled  and  operative  6-16-88  re- 
pealed on  10- 14-88  by  operation  ofGovemment  Code  Section  11346.1  (Regis- 
ter 88,  No.  49). 

4.  New  subsection  (c)  filed  1 1-16-88;  operative  1 1-16-88  pursuant  to  Govern- 
ment Code  Section  1 1346.2(d)  (Register  88,  No.  49). 

§  50405.    Contracts  of  Sale. 

(a)  Property  purchased  under  a  sigtied  contract  of  sale  by  the  applicant 
or  beneficiary  shall  be  included  in  the  property  reserve  of  the  applicant 
or  beneficiary. 

(b)  Property  being  sold  by  the  applicant  or  beneficiary  under  a  signed 
contract  of  sale  shall  not  be  considered  the  property  of  the  applicant  or 
beneficiary.  The  interest  payments  received  under  the  contract  of  sale 
shall  be  unearned  income.  The  principal  payments  received  under  the 
contract  of  sale  shall  be  property. 

(c)  Property  being  purchased  or  sold  under  a  verbal  or  unsigned  con- 
tract of  sale  shall  be  considered  the  property  of  the  seller  until  the  sale  is 
complete. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 
1.  Change  without  regulatory  effect  adding  NOTE  filed  10-1 1-88  (Register  88, 
No.  45). 

§  50406.    Conversion  or  Transfer  of  Property. 

Conversion  or  transfer  of  property  may  affect  eligibility.  Sections 
50407  through  50411  describe  methods  of  converting  or  transferring 
property,  and  the  effect  of  each  method  on  eligibility. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14006  and  14015,  Welfare  and  Institutions  Code. 

History 
1.  Change  without  regulatory  effect  adding  NOTE  filed  10-1 1-88  (Register  88, 

No.  45). 

§  50407.    Conversion  of  Property — Treatment. 

(a)  Conversion  of  property  in  itself  from  one  form  to  another  has  no 
effect  on  eligibility;  however,  the  property  obtained  through  a  conver- 


sion may  have  an  effect  on  eligibility  and  therefore  shall  be  evaluated  to 
determine  its  effect. 

(b)  Insurance  or  other  third-party  payments  for  the  loss  or  damage  of 
property  shall  be  treated  as  converted  property  rather  than  income. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14006  and  14015,  Welfare  and  Institutions  Code. 

History 

1.  Change  without  regulatoi7  effect  addine  NOTE  filed  10-11-88  (Reaister  88, 

No.  45). 


§  50408.    Transfer  of  Property  Which  Does  Not  Result  in 
Ineligibility. 

(a)  Transfer  of  property  shall  not  result  in  ineligibility  for  Medi-Cal 
under  any  of  the  following  conditions: 

(1 )  The  property  would  have  been  considered  exempt  pursuant  to  Sec- 
tion 50418  of  Article  9  of  Division  3  of  this  title  at  the  time  of  transfer. 

(2)  The  net  market  value  of  the  property  transferred,  when  included  in 
the  property  reserve,  would  not  result  in  ineligibility.  The  determination 
of  value  shall  be  made  as  of  the  time  of  transfer.  If  eligibility  exists,  the 
value  of  the  property  shall  no  longer  be  considered. 

(3)  Adequate  consideration  is  received.  Adequate  consideration  is  the 
fair  market  value  of  the  property  as  defined  in  Section  50412  and  in- 
cludes: 

(A)  A  transfer  which  was  to  satisfy  a  legal  debt. 

(B)  A  transfer  which  was  to  reimburse  someone  other  than  a  responsi- 
ble relative,  as  specified  in  Section  50351,  for  care  or  benefits  provided 
on  the  basis  of  an  agreement  or  understanding  that  reimbursement  would 
be  made.  The  applicant  or  beneficiary  shall  provide  evidence  that  clearly 
estabhshes  that  the  value  of  the  care  or  benefits  provided  was  reasonably 
equivalent  to  the  value  of  the  property  transferred. 

(C)  A  written  transmutation  of  a  married  couple's  nonexempt  commu- 
nity property  into  equal  shares  of  separate  property  through  an  interspou- 
sal agreement. 

(4)  Foreclosure  or  repossession  of  the  property  was  imminent  at  the 
time  of  transfer,  and  there  is  no  evidence  of  collusion. 

(5)  The  transfer  was  made  in  return  for  an  enforceable  contract  for  life 
care  which  does  not  include  complete  medical  care.  In  this  case,  each  full 
item  of  need  provided  under  the  life  care  contract  shall  be  considered  in- 
come in  kind  in  accordance  with  Section  50509. 

(6)  The  transfer  was  made  without  adequate  consideration  but  the 
applicant  or  beneficiary  provides  convincing  evidence  to  the  county  as 
specified  in  Section  50409(b),  to  overcome  the  presumption  that  the 


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Page  350.4 


Register  98,  No.  47;  11-20-98 


Title  22 


Health  Care  Services 


§  50412 


transfer  was  for  the  purpose  of  establishing  eligibility  or  reducing  the 
share  of  cost. 

(b)  There  is  a  presumption  that  property  transferred  by  the  applicant 
or  beneficiary  more  than  two  years  preceding  the  date  of  initial  applica- 
tion was  not  transferred  to  establish  eligibility  or  reduce  the  share  of  cost. 
Such  property  shall  not  be  considered  in  determining  eligibility. 

(c)  While  the  transfer  of  property  by  an  applicant  or  beneficiary  from 
one  form  to  another,  as  described  in  (a)  above,  has  no  effect  on  eligibihty, 
any  property  obtained  by  an  applicant  or  beneficiary  through  such  a 
transfer  may  have  an  effect  on  eligibility  and  therefore  shall  be  evaluated 
to  determine  its  effect. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14006,  14006.2  and  14015,  Welfare  and  Institutions 
Code. 

History 

1.  Amendment  of  subsection  (b)  filed  12-15-77;  effective  thirtieth  day  thereafter 
(Register  77,  No.  51). 

2.  Amendment  filed  3-7-80;  effective  thirtieth  day  thereafter  (Register  80,  No.  9). 

3.  New  subsection  (a)(2)(C)  filed  2-16-88  as  an  emergency;  operative  2-16-88 
(Register  88,  No.  10).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL 
within  120  days  or  einergency  language  will  be  repealed  on  6-15-88. 

4.  New  subsecfion  (a)(2)(C)  refiled  6-16-88  as  an  emergency;  operative  6-16-88 
(Register  88,  No.  26).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL 
within  120  days  or  emergency  language  will  be  repealed  on  10-14-88. 

5.  Amendment  filed  6-28-88;  operative  7-28-88  (Register  88,  No.  27). 

6.  New  subsection  (a)(2)(C)  refiled  and  operative  6-16-88  repealed  10-14-88 
pursuant  to  Government  Code  Section  1 1346.1  (Register  88,  No.  49). 

7.  New  subsection  (a)(2)(C)  filed  1 1-1 6-88;  operative  1 1-1 6-88  pursuant  to  Gov- 
ernment Code  Section  1 1346.2(d)  (Register  88,  No.  49). 


§  50409.    Transfer  of  Property  Which  Results  in  Ineligibility. 

(a)  Transfer  of  property  shall  result  in  ineligibility  for  Medi-Cal  if: 

(1)  the  transfer  met  none  of  the  conditions  specified  in  Section  50408; 
or 

(2)  the  transfer  was  in  return  for  an  enforceable  life  care  contract  which 
includes  complete  medical  care. 

(b)  Transfer  of  property  without  adequate  consideration  shall  result  in 
ineligibility  for  Medi-Cal  if  the  transfer  was  made  to  establish  eligibility 
or  to  reduce  the  share  of  cost. 

(J)  It  shall  be  presumed  that  property  transferred  without  adequate 
consideration  was  for  the  purpose  of  establishing  ehgibility  or  to  reduce 
the  share  of  cost  as  limited  by  (2). 

(2)  To  overcome  the  presumption,  the  applicant  or  beneficiary  has  the 
burden  of  establishing  that  this  presumption  is  not  correct. 

(A)  The  applicant  or  beneficiary  shall  provide  evidence  which  may  in- 
clude verification  of  the  onset  of  traumatic  injury  or  illness,  diagnosis  of 
a  previously  undetected  disability  condition  or  unexpected  loss  of  in- 
come or  resources  after  transfer  and/or  that  adequate  resources  were 
available  at  the  time  of  the  transfer  of  property  for  support  and  medical 
care  considering  such  things  as  the  applicant's  or  beneficiary's  age, 
health,  life  expectancy,  and  ability  to  understand  extent  of  resources. 

(B)  Such  evidence  may  also  include  other  subjective  evidence  includ- 
ing, but  not  limited  to.  evidence  that  the  claimant  transferred  in  order  to 
avoid  probate  and/or  that  the  claimant  had  no  knowledge  of  Medi-Cal  or 
its  benefits  at  the  time  of  the  transfer. 

(C)  However,  any  such  evidence  presented  must  be  convincing  evi- 
dence in  order  to  overcome  the  presumption  stated  in  (b)(1)  above. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14006  and  14015,  Welfare  and  Institutions  Code. 

History 

1.  Amendment  of  subsection  (a)  filed  12-15-77;  effective  thirtieth  day  thereafter 
(Register77,  No.  51). 

2.  Editorial  correction  adding  NOTE  filed  6-10-83  (Register  83,  No.  24). 

3.  Amendment  filed  6-28-88;  operative  7-28-88  (Register  88,  No.  27). 


§  50410.    Transfer  of  Property  with  Retention  of  a  Life 
Estate. 

Property  transferred  by  the  applicant  or  beneficiary  with  retention  of 
a  life  estate  shall  be  treated  as  any  other  transfer  to  determine  whether  the 
transfer  results  in  ineligibility. 

Note:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14015,  Welfare  and  Insfitutions  Code. 

History 
1 .  Editorial  correction  adding  NOTE  filed  6-10-83  (Register  83,  No.  24). 

§  5041 1 .     Period  of  Ineligibility  Due  to  Transfer  of  Property. 

(a)  Following  a  determination  of  ineligibility  due  to  the  transfer  of 
property,  there  shall  be  a  period  of  ineligibility.  This  period  shall  be  the 
time  during  which  the  net  market  value  of  the  property  at  the  time  of 
transfer,  less  consideration  received,  would  have  supported  the  applicant 
or  beneficiary  and  the  applicant's  or  beneficiary's  family. 

(b)  The  period  of  ineligibility  shall  be  computed  in  the  following  inan- 
ner: 

Determine  the  net  market  value  of  the  property  at  the  time  of  transfer 
less  any  consideration  received  which  is  the  net  value  of  the  property 
transferred. 

(2)  Determine  the  portion  of  the  net  value  of  the  property  transferred 
which,  if  included  in  the  property  reserve  at  the  time  of  transfer,  would 
not  have  caused  such  reserve  to  exceed  the  property  limit  that  was  appli- 
cable at  that  time. 

(3)  The  portion  of  the  net  value  of  the  property  transferred  that  would 
not  have  fallen  within  the  property  limit  at  the  time  of  transfer  is  the  ex- 
cess net  value  of  the  property  transferred  and  shall  be  used  to  determine 
the  period  of  ineligibility. 

(4)  The  number  of  months  in  the  period  of  ineligibility  shall  be  deter- 
mined by  dividing  the  excess  net  value  of  the  property  transferred  by  the 
monthly  maintenance  need  for  the  applicant  or  beneficiary  and  the  appli- 
cant's or  beneficiary's  family.  The  maintenance  needs  used  shall  be  the 
maintenance  needs  in  effect  during  each  individual  month  since  the  date 
of  the  transfer.  Income  received  by  the  family  after  the  transfer  shall  not 
affect  this  computation. 

(5)  The  period  of  ineligibility  may  be  further  reduced  by  deducting  the 
actual  cost  to  the  applicant  or  beneficiary  of  the  following: 

(A)  Medical  expenses. 

(B)  Out-of-home  care  costs  in  excess  of  the  maintenance  needs. 

(C)  Major  home  repairs  necessary  to  put  the  home  into  a  liveable  con- 
dition. 

(c)  The  period  of  ineligibility  shall  begin  the  first  of  the  month  follow- 
ing the  date  the  transfer  which  resulted  in  ineligibility  occurred,  unless 
a  10  day  notice  is  required  and  cannot  be  given.  In  that  case,  the  period 
of  ineligibility  shall  begin  the  first  of  the  next  month. 

(d)  The  period  of  ineligibility  shall  end  when  any  of  the  following  situ- 
ations occur: 

(1)  The  property  which  was  transferred  and  caused  ineligibility  is  re- 
conveyed  to  the  applicant  or  beneficiary. 

(2)  The  applicant  or  beneficiary  receives  adequate  consideration  for 
the  property. 

(3)  Deduction  of  the  amounts  specified  in  (b)  (4)  and  (5)  has  reduced 
the  excess  net  market  value  to  zero. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14006  and  14015,  Welfare  and  Insfitutions  Code. 

History 

1.  Amendment  of  subsection  (b)(4)  and  (b)(5)  filed  12-15-77;  effective  thirtieth 
day  thereafter  (Register  77,  ^fo.  51). 

2.  Editorial  con-ection  adding  NOTE  filed  6-10-83  (Register  83,  No.  24). 

§  5041 2.     Market  Value  of  Property. 

(a)  The  market  value  of  real  property  shall  be  (1)  or  (2),  unless  the 
applicant  or  beneficiary  chooses  to  meet  the  conditions  of  (3),  and  (3)  is 
lower: 

(1)  The  assessed  value  determined  under  the  most  recent  property  tax 
assessment,  if  the  property  is  located  in  California. 


Page  351 


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§  50413 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


(2)  The  value  established  by  applying  the  assessment  method  used  in 
the  area  where  the  property  is  located,  if  the  property  is  located  outside 
of  California. 

(3)  The  value  established  as  the  result  of  an  appraisal  by  a  qualified  real 
estate  appraiser,  if  the  appraisal  is  obtained  by  the  applicant  or  beneficia- 
ry and  provided  to  the  county  department. 

(b)  The  market  value  of  each  item  of  personal  property  shall  be  deter- 
mined by  the  specific  methods  contained  in  this  article. 

(c)  The  market  value  of  notes  secured  by  deeds  of  trust  and  mortgages 
which  are  considered  as  other  real  property  in  accordance  with  Section 
50441(b)  shall  be  established  in  accordance  with  Section  50441(c). 

NOTE;  Authority  cited;  Sections  10725,  14006.1  and  14124.5,  Welfaie  and  Insti- 
tutions Code;  and  Section  57,  Chapter  328,  Statutes  of  1982.  Reference;  Sections 
1 1 153.7  and  14006,  Welfare  and  Institutions  Code. 

History 

1 .  Amendment  filed  1-28-77  as  an  emergency;  effective  upon  filing  (Register  77, 
No.  5). 

2.  Certificate  of  Compliance  filed  4-22-77  (Register  77,  No.  17). 

3.  Amendment  of  subsections  (a)(3)  and  (c)  filed  5-6-81;  effective  thirtieth  day 
thereafter  (Register  81 ,  No.  19). 

4.  Amendment  of  subsection  (a)(1)  filed  12-31-82  as  an  emergency;  effective 
upon  filing  (Register  83,  No.  2).  A  Certificate  of  Compliance  must  be  trans- 
mitted to  OAL  within  120  days  or  emergency  language  will  be  repealed  on 
4-30-83. 

5.  Certificate  of  Compliance  transmitted  to  OAL  4-29-83  and  filed  6-3-83  (Reg- 
ister 83,  No.  23). 

6.  Amendment  of  subsection  (a)(3)  filed  7-24-84  as  an  emergency;  effective  upon 
filing  (Register  84,  No.  31).  A  Certificate  of  Compliance  must  be  transmitted 
to  OAL  within  120  days  or  emergency  language  will  be  repealed  on  11-21-84. 

7.  Order  of  Repeal  of  7-24-84  emergency  order  filed  12-20-84  by  OAL  pursuant 
to  Government  Code  Section  1 1349.6  (Register  84,  No.  51). 

8.  Amendment  of  subsection  (a)(3)  filed  12-2-85  as  an  emergency;  effective  upon 
filing  (Register  85,  No.  50).  A  Certificate  of  Compliance  must  be  transmitted 
to  OAL  within  120  days  or  emergency  language  will  be  repealed  on  4-1-86. 

9.  Certificate  of  Compliance  transmitted  to  OAL  3-31-86  and  filed  4-30-86 
(Register  86,  No.  18). 

§50413.     Encumbrances. 

(a)  Encumbrances  of  record  are  obligations  for  which  the  property  is 
security.  Encumbrances  include,  but  are  not  limited  to: 

(1)  Loans. 

(2)  Attachments  for  debts  and  taxes. 

(3)  Chattel  mortgages  and  liens. 

NOTE:  Authority  cited;  Sections  10725  and  14124.5,  Welfare  and  Institufions 
Code.  Reference;  Section  14006,  Welfare  and  Institutions  Code. 

History 
1.  Editorial  con-ection  adding  NOTE  filed  6-10-83  (Register  83,  No.  24). 

§  50414.    Share  of  Encumbrances  Determination. 

(a)  The  share  of  encumbrances  shall  be  determined  as  follows: 

(1)  Determine  the  total  market  value  of  the  property. 

(2)  Determine  the  market  value  of  the  portion  of  the  property  that  is 
to  be  considered. 

(3)  Divide  the  amount  determined  in  (2)  by  the  amount  determined  in 
(1)  to  obtain  the  percentage  that  the  portion  of  property  is  of  the  total 
property. 

(4)  Multiply  the  total  encumbrances  on  the  property  by  the  percentage 
determined  in  (3)  above.  This  is  the  share  of  encumbrances. 

§50415.    Net  Market  Value  of  Property. 

(a)  The  net  market  value  of  real  or  personal  property  is  the  owner's  eq- 
uity in  that  property. 

(b)  The  net  market  value  shall  be  determined  by  subtracting  the  en- 
cumbrances of  record  from  the  market  value. 

(c)  The  net  market  value  of  real  or  personal  property  owned  jointly 
with  other  persons  shall  be  determined  by  subtracting  the  beneficiary's 
share  of  encumbrances  from  the  beneficiary's  interest  in  the  property. 
Note.  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference;  Section  14006,  Welfare  and  Institufions  Code. 

History 
1.  Change  without  regulatory  effect  adding  NOTE  filed  10-1 1-88  (Register  88, 
No.  45). 


§  50416.    Utilization  Requirements. 

(a)  Other  real  property,  as  specified  in  Section  50427(b),  shall  be  uti- 
lized in  order  to  be  exempt  unless  the  net  market  value,  when  added  to 
the  net  market  vakie  of  other  nonexempt  property,  falls  within  the  limits 
set  forth  in  Section  50420. 

(b)  The  property  is  utilized  if  any  of  the  following  requirements  are 
inet: 

(1 )  The  beneficiary  is  receiving  net  yearly  income  from  the  property 
of  at  least  six  percent  of  the  net  market  value  of  the  property. 

(A)  For  property  not  limited  to  .seasonal  use,  this  requirement  is  met 
if  the  net  monthly  income  from  the  property  is  one-twelfth  of  six  percent 
of  the  net  market  value  of  the  property. 

(B)  For  property  hmited  to  seasonal  use,  this  requirement  is  inet  if  the 
net  yearly  income  is  six  percent  of  the  net  market  value  of  the  property. 
Property  limited  to  seasonal  use  includes,  but  is  not  limited  to: 

L  Farmland. 

2.  Summer  cabins. 

(C)  For  purpose  of  determining  net  yearly  income  frotn  property  lim- 
ited to  seasonal  use,  the  year  is  considered  to  begin  in  the  first  month  of 
the  year  in  which  income  normally  begins.  Income  from  all  months  of  the 
year  shall  be  considered  in  determining  net  yearly  income  of  the  proper- 
ty, regardless  of  the  eligibility  status  of  the  beneficiary  in  those  months. 

(2)  The  property  has  been  sold,  or  the  sale  is  in  escrow  and  there  is  a 
bona  fide  attempt  to  close  the  sale. 

(c)  The  applicant  or  beneficiary  shall  be  allowed  six  months  to  meet 
utilization  requirements.  The  six  month  period  shall  be  known  as  the  uti- 
lization period,  and  shall  begin  on  the  first  of  the  month  following  is- 
suance of  a  notice  of  action  informing  the  applicant  or  beneficiary  that 
the  property  is  not  yielding  sufficient  income,  as  required  in  (b).  The  utili- 
zation period  shall  be  stayed  during  periods  of  ineligibility  in  accordance 
with  (1). 

(d)  The  utilization  period  may  be  extended  for  a  maximum  of  one  year 
for  good  cause,  as  specified  in  Section  50417. 

(e)  The  utilization  period  shall  be  extended  for  as  long  as  the  property 
is  Hsted  for  sale,  provided  all  of  the  following  conditions  are  met: 

(1)  The  county  department  determines  that  utilization  requirements 
can  only  be  met  by  sale  of  the  property.  This  determination  shall  be  made 
using  evidence  provided  by  the  applicant  or  beneficiary,  which  may  be, 
but  is  not  limited  to,  either  of  the  following: 

(A)  A  written  statement  from  a  qualified  real  estate  appraiser  which 
gives  the  appraisal  value  of  the  property  and  its  income  poteniial. 

(B)  A  certificate  of  condemnation. 

(2)  The  property  is  listed  for  sale  with  a  licensed  real  estate  broker  at 
the  market  value,  as  determined  in  accordance  with  Section  50412(a). 

(3)  The  beneficiary  provides  the  following  evidence  every  six  months, 
and  at  any  other  time  it  is  requested  by  the  county  department: 

(A)  A  statement  from  the  real  estate  agency  that  no  bona  fide  offer  has 
been  rejected. 

(B)  Copies  of  any  offers  that  have  been  submitted  and  the  reasons  for 
rejection. 

(C)  Evidence  of  the  efforts  being  made  to  advertise  the  property  for 
sale. 

(f)  If  the  apphcant  or  beneficiary  utilizes  the  property  by  sale,  the  prop- 
erty shall  be  sold  for  at  least  market  value,  unless  the  property  was  sold 
under  either  of  the  following  situations,  and  the  applicant  or  beneficiary 
submits  evidence  that  there  was  a  bona  fide  attempt  to  sell  at  market  val- 
ue. 

( 1 )  The  property  was  listed  with  a  hcensed  real  estate  broker  for  at  least 
three  inonths  and  the  final  sale  price  was  similar  to  comparable  sales  in 
the  area. 

(2)  There  was  an  inability  to  sell  the  property  for  the  market  value  and 
the  county  department  determines  that  the  final  sale  price  was  reason- 
able. 


Page  352 


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Title  22 


Health  Care  Services 


§  50420 


• 


(g)  An  existing  environmental  impact  report  involving  a  property  shall 
be  considered  by  the  county  department  in  determining  the  utilization  po- 
tential of  the  property. 

(h)  A  life  estate  interest  in  real  property  shall  be  utilized  in  accordance 
with  this  section. 

(i)  The  applicant  or  beneficiary  may  arrange  for  a  reassessment  of  the 
property  during  the  utilization  period.  The  assessment  shall  affect  utiliza- 
tion as  follows: 

(1 )  The  reassessment  value  shall  be  used  in  determining  utilization  re- 
quirements. 

(2)  The  reassessment  shall  not  affect  the  beginning  date  or  the  length 
of  the  utilization  period. 

(j)  The  entire  net  market  value  of  property  not  utilized  in  accordance 
with  this  section  shall  be  included  in  the  property  reserve  on  the  first  of 
the  month  following  the  last  month  of  the  utilization  period. 

(k)  A  utilization  period  shall  begin  whenever: 

(1 )  An  applicant,  with  other  real  property  that  is  not  being  utilized,  be- 
comes eligible  except  as  specified  in  (1). 

(2)  The  other  real  property  of  a  beneficiary,  that  has  been  utilized,  is 
no  longer  utilized. 

(3)  The  net  market  value  of  other  real  property,  when  added  to  the  net 
market  value  of  other  nonexempt  property,  no  longer  falls  within  the  lim- 
its set  forth  in  Section  50420. 

(/ )  When  a  utilization  period  has  begun  and  the  beneficiary  becomes 
ineligible  for  Medi-Cal  prior  to  its  expiration,  the  remainder  of  the  utili- 
zation period  shaU  be  applied  if  eligibility  is  subsequently  reestablished 
and  the  property  is  not  utilized  at  that  time.  However,  if  the  beneficiary 
can  verify  that  the  property  was  utilized  at  any  time  during  the  period  of 
ineligibility,  a  new  utilization  period  shall  begin. 

NOTE:  Authority  cited:  Sections  10725, 14006.1  and  14124.5,  Welfare  and  Insti- 
tutions Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 

1.  Amendment  of  subsections  (e)(1)(A)  and  (k)  filed  12-2-85  as  an  emergency; 
effective  upon  filing  (Register  85,  No.  50).  A  Certificate  of  Compliance  must 
be  transmitted  to  OAL  within  120  days  or  emergency  language  will  be  repealed 
on  4-1-86.  For  prior  history,  see  Register  83,  No.  4. 

2.  Certificate  of  Compliance  transmitted  to  OAL  3-31-86  and  filed  4-30-86 
(Register  86,  No.  18). 


§  50417.    Utilization— Good  Cause. 

(a)  Good  cause,  as  required  in  Section  50416  (d),  shall  be  found  only 
if  the  applicant  or  beneficiary  has  made  a  bona  fide  effort  to  meet  utiliza- 
tion requirements  and  is  unable  to  do  so  because  of  circumstances  be- 
yond such  person's  control. 


(b)  Circumstances  beyond  a  person's  control  shall  include  any  of  the 
following  situations: 

(1)  Death  of  a  part  owner  of  the  property  and  inability  or  refusal  of  the 
administrator  or  executor  of  the  estate  or  other  responsible  person  to 
complete  disposition  of  the  property  if  such  person  is  other  than  the  appli- 
cant or  beneficiary. 

(2)  Misplaced  reliance  by  the  applicant  or  beneficiary  upon  what  ap- 
peared to  be  a  bona  fide  offer.  The  county  department  shall  require  a  copy 
of  the  written  offer  for  the  property  as  evidence  that  the  offer  was  bona 
fide.  Misplaced  reliance  may  have  resulted  if  the  offer  was  either  of  the 
following: 

(A)  Bona  fide  but  the  purchaser  was  unable  to  complete  the  purchase. 

(B)  Apparently  bona  fide  but  eventually  found  not  to  be  bona  fide. 

(3)  Prolonged  illness  causing  the  seller  to  be  homebound  or  hospital- 
ized during  the  ufihzation  period  and  unable  to  take  the  necessary  action 
to  meet  utilizafion  requirements  or  to  arrange  for  an  agent  to  do  so. 

(4)  Like  reasons  which  the  county  department  determines  meet  the 
general  intent  of  good  cause. 

NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  1 1 153.7  and  14006,  Welfare  and  Institutions  Code. 

History 
1.  Editorial  correction  filed  6-10-83  (Register  83,  No.  24). 

§50418.    Exemption  of  Property. 

(a)  Certain  real  and  personal  property  is  exempt  and  shall  not  be  in- 
cluded in  determining  eligibility.  These  property  exemptions  are  speci- 
fied in  Sections  50425  through  50489. 

(b)  All  real  and  personal  property  not  exempt  as  specified  in  (a)  is  non- 
exempt  property. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14006,  Welfaie  and  Institutions  Code. 

History 

1.  Change  without  regulatory  effect  adding  NOTE  filed  10-1 1-88  (Register  88, 

No.  45). 

§50419.    Property  Reserve. 

The  property  reserve  is  the  net  market  value  of  the  nonexempt  property 
of  those  persons  whose  property  is  considered  in  determining  the  eligibil- 
ity of  the  MFBU. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institufions 
Code.  Reference:  Section  14006,  Welfare  and  Institufions  Code. 

History 
1.  Change  without  regulatory  effect  adding  NOTE  filed  10-1 1-88  (Register  88, 

No.  45). 

§  50420.    Property  Limit. 

(a)  The  property  reserve  shall  not  exceed  the  following  limits. 


Number  of  Persons  Property 

Whose  Property  is  Limit 

Considered  1985 

1  person   1,600 

2  persons 2,400 

3  persons 2,550 

4  persons 2,700 

5  persons 2,850 

6  persons 3,000 

7  persons 3,150 

8  persons 3,300 

9  persons 3,450 

10  persons  or  more 3,600 


Property 
Limit 
1986 

1,700 
2,550 
2,700 
2,850 
3,000 
3,150 
3,300 
3,450 
3,600 
3,750 


'roperty 

Property 

Limit 

Limit 

1987 

1988 

1,800 

1,900 

2,700 

2,850 

2,850 

3,000 

3,000 

3,150 

3,150 

3,300 

3,300 

3,450 

3,450 

3,600 

3,600 

3,750 

3,750 

3,900 

3,900 

4,050 

Property 
Limit 
1989 

2,000 
3,000 
3,150 
3,300 
3,450 
3,600 
3,750 
3.900 
4.050 
4,200 


Page  353 


Register  93,  Nos.  52-53;  12-31  -93 


§  50420.5 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


(b)  The  members  of  the  MFBU  shall  be  ineligible  for  Medi-Cal  if  the 
condition  specified  in  (a)  above  is  not  met  at  some  time  during  the  month 
in  which  application  is  made. 

(c)  If  the  property  reserve  has  been  in  excess  of  the  property  limit  from 
the  first  day  of  the  month  of  application  through  the  date  of  application 
the  MFBU  shall  be  eligible  under  the  following  conditions: 

(1)  The  property  reserve  is  brought  within  the  property  limit  in  any 
manner  other  than  transfer  without  adequate  consideration  by  the  last  day 
of  the  month  of  application. 

(2)  All  other  conditions  of  eligibility  are  met. 

(d)  The  provisions  of  this  regulation  also  apply  to  eligibility  determi- 
nations or  redeterminations  made  retroactively  to  January  1,  1985. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  and  Section  57(c),  Chapter  328,  Statutes  of  1982.  Reference:  Sections 
14006  and  14019.6,  Welfare  and  Institutions  Code. 

History 

1 .  Amendment  of  subsection  (a),  (b)  and  new  subsection  (d)  filed  4-15-85  as  an 
emergency;  effective  upon  filing  (Register  85,  No.  16).  A  Certificate  of  Com- 
pliance must  be  transmitted  to  OAL  within  120  days  or  emergency  language 
will  be  repealed  on  8-13-85.  For  prior  history,  see  Register  83,  No.  16. 

2.  Certificate  of  Compliance  as  to  4-15-85  order  transmitted  to  OAL  8-13-85  and 
filed  9-18-85  (Register  85,  No.  38). 

§  50420.5.    Separation  of  Community  Property:  Spouse  in 
Long-Term  Care  Facility. 

(a)  The  value  of  property  available  to  an  applicant  or  beneficiary  who 
is  in  a  skilled  nursing  or  intermediate  care  facility  and  is  in  a  MFBU  sepa- 
rate from  his  or  her  spouse  shall  be  determined  to  meet  the  property  re- 
serve limits  if  the  value  as  determined  in  (1)(E)  or  (2)(D)  of  this  subsec- 
tion is  equal  to  or  less  than  the  applicable  property  reserve  limit. 

(1)  If  the  applicant  or  beneficiary  has  entered  into  an  interspousal 
agreement  prior  to  or  on  the  date  of  entry  into  a  skilled  nursing  or  interme- 
diate care  facility  and  the  agreement  meets  the  requirements  set  forth  in 
section  50403(c)  and  (d),  the  county  shall  determine: 

(A)  The  value  of  the  applicant  or  beneficiary's  nonexempt  separate 
property  resulting  from  the  interspousal  agreement. 

(B)  The  value  of  the  applicant  or  beneficiary's  one-half  share  of  any 
nonexempt  community  property  acquired  since  or  not  included  in  the  in- 
terspousal agreement. 

(C)  The  value  of  the  applicant  or  beneficiary's  nonexempt  separate 
property  from  sources  other  than  the  interspousal  agreement. 

(D)  Tlie  value  of  any  nonexempt  separate  property  owned  by  the  appli- 
cant or  beneficiary's  spouse  and/or  the  applicant  or  beneficiary's 
spouse's  share  of  nonexempt  community  property  which  is  actually 
made  available  to  the  applicant  or  beneficiary. 

(E)  The  value  of  property  determined  in  (a)(1)(A)  through  (D)  of  this 
section  remaining  after  deducting  expenditures  made  for  the  applicant  or 
beneficiary's  own  benefit  as  defined  in  (b)  of  this  section  and  verified 
losses,  if  any,  in  the  market  value  of  such  property  since  the  date  of  the 
interspousal  agreement. 

(2)  If  the  date  the  interspousal  agreement  was  executed  is  later  than  the 
date  of  entry  into  a  skilled  nursing  or  intermediate  care  facility,  or  in  the 
absence  of  an  interspousal  agreement  which  meets  the  requirements  of 
section  50403  (c),  (d)  and  (e),  the  county  shall  determine: 

(A)  The  value  of  the  applicant  or  beneficiary's  nonexempt  separate 
and  one-half  share  of  nonexempt  community  property  on  the  date  of 
most  recent  entry,  as  limited  by  (d)  of  this  section,  into  a  skilled  nursing 
or  intermediate  care  facility. 

(B)  The  value  of  the  applicant  or  beneficiary's  share  of  any  nonexempt 
separate  and  one-half  share  of  nonexempt  community  property  acquired 
from  the  date  of  most  recent  entry  into  a  skilled  nursing  or  intermediate 
care  facility  to  the  date  eligibility  is  determined. 

(C)  The  value  of  any  nonexempt  separate  property  owned  by  the  appli- 
cant or  beneficiary's  spouse  and/or  the  applicant  or  beneficiary's 
spouse's  share  of  nonexempt  community  property  which  is  actually 
made  available  to  the  applicant  or  beneficiary. 


(D)  The  value  of  property  determined  in  (a)(2)(A)  through  (C)  of  this 
section  remaining  after  deducting  expenditures  made  for  the  applicant  or 
beneficiary's  own  benefit,  as  defined  in  (b)  of  this  section,  and  verified 
losses,  if  any,  in  the  market  value  of  such  property  since  the  date  of  entry 
into  a  skilled  nursing  or  intermediate  care  facility. 

(b)  Expenditures  for  the  applicant  or  beneficiary's  own  benefit  shall 
include  but  are  not  limited  to: 

(1)  Expenditures  for  the  applicant  or  beneficiary's  own  medical  ex- 
penses. 

(2)  Expenditures  associated  with  property  owned  by  the  applicant  or 
beneficiary  and  for  improvements  to  such  property  in  proportion  to  his 
or  her  ownership  interest  in  the  property,  for  example. 

(A)  Payments  made  on  the  mortgage  on  a  jointly  owned  principal  resi- 
dence. 

(B)  Payments  made  on  a  note  on  a  jointly  owned  motor  vehicle. 

(C)  Expenditures  for  improvements  on  a  jointly  owned  principal  resi- 
dence. 

(3)  Expenditures  for  other  exempt  or  nonexempt  property  for  the  sole 
benefit  of  the  applicant  or  beneficiary  including,  but  not  limited  to,  per- 
sonal effects,  recreational  items,  and  burial  trusts. 

(4)  Transfer  of  nonexempt  assets  for  adequate  consideration  as  de- 
fined in  50408(a)(3). 

(c)  For  purposes  of  this  section,  it  shall  be  presumed  that  all  property 
is  community  property.  This  presumpfion  may  be  rebutted  by  either 
spouse. 

(d)  The  mere  change  of  residence  from  one  medical  facility  to  another 
shall  not  be  considered  a  new  entry  into  LTC  for  purposes  of  subsecUon 
(a)  of  this  section. 

(e)  Effective  1/1/90,  the  regulations  contained  in  this  section  shall  not 
apply  to  an  institutionalized  spouse  as  defined  by  secfion  1924  (h)(1)  of 
Title  XIX  of  the  Social  Security  Act. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14006,  14006.2  and  14008,  Welfaie  and  Institutions 
Code;  and  Section  1924,  Title  XIX,  Social  Security  Act  (Section  1396r-5,  Title 
42,  United  States  Code). 

History 

1.  New  section  filed  10-13-89  as  an  emergency  pursuant  to  Sections  5  and  6(d) 
of  Chapter  1221,  Statutes  of  1985;  operative  10-13-89  (Register  89.  No.  44). 
A  Certificate  of  Compliance  must  be  transmitted  to  OAL  v/ithin  120  days  or 
emergency  language  will  be  repealed  on  2-13-90. 

2.  New  section  filed  2-26-90  as  an  emergency  pursuant  to  Sections  5  and  6(d)  of 
Chapter  1221,  Statutes  of  1985;  operative  2-26-90  (Register  90,  No.  9).  A  Cer- 
tificate of  Compliance  must  be  transmitted  to  OAL  within  120  days  or  emergen- 
cy language  will  be  repealed  by  operation  of  law  on  6-26-90. 

3.  Certificate  of  Compliance  as  to  2-26-90  order  including  amendment  of  subsec- 
tions (a)  and  (b)  transmitted  to  OAL  6-8-90  and  filed  7-9-90  (Register  90,  No. 
34). 

§  50421.     Limits  and  l\/lethods  of  Property  Determination  for 
the  Qualified  IVIedicare  Beneficiary  (QiVIB)  or 
the  Specified  Low-Income  Medicare 
Beneficiary  (SLMB). 

(a)  To  qualify  for  the  QMB  or  SLMB  programs,  the  net  nonexempt 
property  of  a  QMB  or  SLMB  applicant/beneficiary  cannot  exceed  twice 
the  Supplemental  Security  Income  (SSI)  program  property  limit. 

(1)  Adult. 

(A)  A  QMB  or  SLMB  applicant/beneficiary  who  is  married  or  is  IB 
years  of  age  or  older  shall  be  considered  an  adult  for  pur{)oses  of  this  sec- 
tion. 

(B)  Only  the  property  of  the  QMB  or  SLMB  applicant/beneficiary  and 
his/her  spouse,  if  living  in  the  home,  shall  be  considered  in  determining 
net  nonexempt  property.  Such  property  shall  be  determined  in  accor- 
dance with  Article  9  and  shall  be  compared  to  twice  the  SSI  property  limit 
for  one  person  (or  two  persons,  if  the  spouse  is  living  in  the  home). 

(2)  Child. 

(A)  A  QMB  or  SLMB  applicant/beneficiary  who  is  unmarried  and 
younger  than  18  years  of  age  shall  be  considered  a  child  for  purposes  of 
this  section. 


Page  354 


Register  93,  Nos.  52-53;  12-31-93 


Title  22 


Health  Care  Services 


§  50425 


(B)  Net  nonexeinpt  property  shall  be  determined  in  accordance  with 
article  9.  Only  the  property  of  the  QMB  or  SLMB  child  and  his/her  par- 
ent(s)  shall  be  considered  in  determining  net  nonexempt  property.  For 
purposes  of  this  subsection,  the  parent(s)  includes  stepparent(s). 

(C)  The  parent(s)'s  net  nonexempt  property  shall  be  compared  to  the 
SSI  property  limit  for  one  or  two  persons  (depending  upon  the  number 
of  parents  in  the  home).  If  the  parent(s)'s  net  nonexempt  property  does 
not  exceed  this  property  limit,  only  the  QMB  or  SLMB  child's  property 
shall  be  considered.  If  the  parent(s)'s  net  nonexempt  property  exceeds 
the  SSI  property  limit,  the  excess  amount  over  the  SSI  property  limit  shall 
be  added  to  the  QMB  or  SLMB  child's  own  net  nonexempt  property.  The 
QMB  or  SLMB  child's  total  net  nonexempt  property  shall  be  compared 
to  twice  the  Medi-Cal  property  limit  for  one  person. 

(D)  If  there  are  two  or  more  QMB  or  SLMB  children  in  the  home,  the 
excess  amount  of  the  parent(s)'s  net  nonexempt  property  over  the  SSI 
property  limit  shall  be  divided  by  the  number  of  QMB  or  SLMB  children 
and  that  quotient  added  to  each  child's  net  nonexempt  property.  The  net 
nonexempt  property  of  the  QMB  or  SLMB  child  shall  no  longer  be  in- 
creased by  his/her  share  of  the  parental  allocation  when: 

1.  The  parental  allocation  of  net  nonexempt  property  when  added  to 
the  QMB  or  SLMB  child's  own  net  nonexempt  property  exceeds  twice 
the  SSI  property  limit  for  one  person,  or 

2.  The  QMB  or  SLMB  child  is  found  ineligible  as  a  QMB  or  SLMB 
for  any  other  reason.  When  a  QMB  or  SLMB  child  no  longer  qualifies 
to  receive  a  share  of  the  parent(s)'s  nonexempt  property,  the  parent(s)'s 
net  nonexempt  property  shall  then  be  redi  vided  by  the  number  of  remain- 
ing QMB  or  SLMB  children  in  the  home  and  that  quotient  added  to  the 
net  nonexempt  property  of  each  of  those  children. 

NOTE:  Authority  cited:  Sections  10725, 14005.11  and  14124.5,  Welfare  and  Insti- 
tutions Code;  and  Section  12,  Chapter  1430,  Statutes  of  1989. Reference:  Sections 
416. 1202  and  416.1205,  Title  20,  Code  of  Federal  Regulations;  Section  1396a(a), 
Title  42,  United  States  Code;  and  Section  14005.11,  Welfare  and  Institutions 
Code. 

History 

1.  New  section  filed  8-13-90  as  an  emergency;  operative  8-13-90  (Register  90, 
No.  40).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  12-11-90 
or  emergency  language  will  be  repealed  by  operation  of  law  on  the  following 
day. 

2.  Certificate  of  Compliance  transmitted  to  OAL  12-11-90  and  filed  1-9-91 
(Register  91,  No.  8). 

3.  Amendment  filed  12-21-93;  operative  1-20-94  (Register  93,  No.  52). 

§  50421 .5.     Limits  and  Methods  of  Property  Determination 
for  the  Qualified  Disabled  and  Working 
Individual  (QDWI). 

(a)  To  qualify  for  the  QDWI  program,  the  net  nonexempt  property  of 
a  QDWI  applicant/beneficiary  cannot  exceed  twice  the  Supplemental  Se- 
curity Income  (SSI)  resource  limit  in  accordance  with  Section  1613,  Title 
XVI  of  the  Social  Security  Act. 

(b)  Only  the  property  of  the  QDWI  applicant/beneficiary  and,  if  mar- 
ried, his/her  spouse,  if  living  in  the  home,  shall  be  considered  in  deter- 
mining net  nonexempt  property.  Such  property  shall  be  determined  in  ac- 
cordance with  Section  50420. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  and  Section  12,  Chapter  1430,  Statutes  of  1989.  Reference:  Section 
14005.3,  Welfare  and  Institutions  Code;  and  Sections  I396a(a)(]0)(E)  and 
1396d(s),  Title  42,  United  States  Code. 

History 

1.  New  section  filed  10-3-94  as  an  emergency;  operative  10-3-94  (Register  94, 
No.  40).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  1-31-95 
or  emergency  language  will  be  repealed  by  operation  of  law  on  the  following 
day. 

2.  Editorial  correction  of  History  Note  1  (Register  95,  No.  9). 

3.  Repealed  by  operation  of  Government  Code  section  11346.1(g)  (Register  95, 
No.  9). 

4.  New  section  refiled  3-3-95  as  an  emergency;  operative  3-3-95  (Register  95, 
No.  9).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  7-1-95  or 
emergency  language  will  be  repealed  by  operation  of  law  on  the  following  day. 

5.  Certificate  of  Compliance  as  to  3-3-95  order  including  amendment  of  subsec- 
tion (b)  and  Note  transmitted  to  OAL  2-22-95  and  filed  4-5-95  (Register  95, 
No.  14). 


§  50422.     Liens. 

NOTE:  Authority  cited:  Sections  10725,  14006.1  and  14124.5.  Welfare  and  Insti- 
tutions Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 

1 .  New  section  filed  7-24-84  as  an  emergency;  effective  upon  filing  (Register  84, 
No.  31).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  1 1-21-84. 

2.  Order  of  Repeal  of  7-24-84  emergency  order  filed  1 2-20-84  by  OAL  pursuant 
to  Goveminent  Code  Section  1 1349.6  (Register  84,  No.  51). 

§  50423.     Items  of  Property  to  Be  Considered. 

(a)  The  items  of  property  to  be  considered  in  determining  eligibility 
are  described  in  Sections  50425  through  50489.  Each  of  these  sections 
indicates: 

(1)  Whether  all  or  a  portion  of  the  item  of  property  is  exempt. 

(2)  The  method  for  determining  the  net  market  value  of  the  specific 
item  of  property. 

(3)  Any  other  information  necessary  to  evaluate  the  property. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Insututions 
Code.  Reference:  Section  14006,  Welfare  and  Institufions  Code. 

History 
1.  Change  without  regulatory  effect  adding  NOTE  filed  10-1 1-88  (Register  88, 
No.  45). 

§  50425.     Property  Used  As  a  Principal  Residence. 

(a)  A  principal  residence  may  consist  of  real  or  personal  property, 
fixed  or  mobile,  located  on  land  or  water.  The  principal  residence  in- 
cludes land  or  buildings  surrounding,  contiguous  to,  or  appertaining  to 
the  residence. 

(b)  The  following  items  of  real  property  may  serve  as  a  principal  resi- 
dence: 

(1)  A  house. 

(2)  The  entire  multiple  unit  dwelling  if  any  portion  of  the  multiple  unit 
dwelling  serves  as  the  principal  residence  of  the  applicant  or  benefici  ary . 

(3)  The  items  listed  in  (d).  These  items  shall  be  considered  as  real  prop- 
erty when  they  are  assessed  as  real  property  by  the  county  assessor  of  the 
county  in  which  the  property  is  located. 

(c)  Property  which  the  applicant  or  beneficiary  uses  or  formerly  used 
as  a  home  shall  be  exempt  as  the  principal  residence  if  any  of  the  follow- 
ing situations  exist: 

(1)  The  applicant  or  beneficiary  lives  on  the  property. 

(2)  The  family  of  the  applicant  or  beneficiary  lives  on  the  property  and 
Medi-Cal  eligibility  is  determined  in  either  of  the  following  ways: 

(A)  With  the  applicant  or  beneficiary  and  the  family  in  a  single  MFBU. 

(B)  With  the  income  of  the  family  considered  in  determining  the  appli- 
cant's or  beneficiary's  eligibility. 

(3)  The  applicant  or  beneficiary  is  absent  from  the  property  for  any  rea- 
son, including  admittance  to  LTC,  and  declares  in  writing  that  he/she  in- 
tends to  return  to  the  property  to  live. 

(4)  The  applicant  or  beneficiary  is  absent  from  the  property  and  has  a 
spouse,  child  under  age  2 1  or  a  dependent  relative,  who  lives  on  the  prop- 
erty. A  disabled  child  age  21  or  older  is  considered  a  dependent  relative 
for  purposes  of  this  regulation  only. 

(5)  A  sibling  or  child  age  21  or  over  of  the  applicant  or  beneficiary  has 
continuously  resided  on  the  property  for  at  least  one  year  immediately 
prior  to  the  date  the  applicant  or  beneficiary  entered  a  SNF  or  ICF  and 
continues  to  reside  there. 

(6)  The  property  cannot  be  sold  because  there  are  legal  obstacles  pre- 
venting the  sale  and  the  applicant  or  beneficiary  or  person  acting  on  his/ 
her  behalf  provides  evidence  of  attempts  to  overcome  such  obstacles. 

(7)  The  applicant  or  beneficiary  no  longer  lives  on  the  property,  does 
not  intend  to  return  to  the  property,  the  property  is  not  otherwise  exempt 
and  the  property  cannot  be  readily  converted  to  cash  but  a  bona  fide  effort 
is  being  made  to  sell  the  property.  A  bona  fide  effort  to  sell  means  that 
the  property  is  listed  for  sale  with  a  licensed  real  estate  broker  for  its  fair 
market  value  established  by  a  qualified  real  estate  appraiser,  a  good  faith 
effort  is  being  made  to  sell  the  property,  offers  at  fair  market  value  are 
accepted,  and  the  applicant  or  beneficiary  has  supplied  proof  of  com- 
pliance with  these  condifions  to  the  county. 


Page  355 


Register  95,  No.  14;  4-7-95 


§  50426 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


(d)  The  following  items  of  personal  property  may  serve  as  a  principal 
residence: 

(1)  A  mobile  home. 

(2)  A  houseboat. 

(3)  A  motor  vehicle  used  as  a  residence. 

(4)  Any  other  shelter  not  attached  to  the  land  and  used  as  a  residence. 

(e)  Only  one  property  may  be  exempt  as  the  principal  residence. 

(0  Real  property  formerly  used  as  a  principal  residence  shall  be  con- 
sidered other  real  property,  effective  the  first  of  the  month  following  the 
date  the  property  is  no  longer  used  as  a  principal  residence  as  specified 
in  (a).  Such  property  shall  be  subject  to  all  conditions  placed  upon  other 
real  property  in  these  regulations. 

(g)  Personal  property  formerly  used  as  a  principal  residence  shall  be 
evaluated  as  an  item  of  personal  property  beginning  the  first  of  the  month 
following  the  date  the  property  is  no  longer  used  as  a  principal  residence 
as  specified  in  (c). 

NOTE:  Authority  cited:  Sections  10725,  14006.1  and  14124.5,  Welfare  and  Insti- 
tutions Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 

1 .  Amendment  filed  12-2-85  as  an  emergency;  effective  upon  filing  (Register  85, 
No.  50).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  4-1-86.  For  prior  history,  see 
Register  84,  No.  51. 

2.  Certificate  of  Compliance  including  amendment  of  subsections  (a)-(c)  trans- 
mitted to  OAL  3-31-86  and  filed  4-30-86  (Register  86,  No.  18). 

3.  Change  without  regulatory  effect  of  subsection  (g)  (Register  87,  No.  11). 

§  50426.    Property  Used  to  Purchase  a  Principal  Residence. 

(a)  The  proceeds  from  the  sale  of  real  property  retained  by  an  applicant 
or  beneficiary  who  does  not  own  a  suitable  principal  residence  or  who 
wishes  to  sell  the  current  principal  residence  and  purchase  a  new  princi- 
pal residence  shall  be  exempt  for  a  period  of  six  months  from  the  date  of 
receipt  of  the  proceeds  so  long  as  the  proceeds  from  the  sale  of  the  real 
property  are  intended  to  be  used  to  purchase  a  principal  residence.  Such 
proceeds  may  also  be  applied  to  the  costs  of  moving,  necessary  furnish- 
ings, and  repair  or  alteration  to  the  principal  residence. 

(b)  If  a  portion  of  the  proceeds  specified  in  (a)  is  diverted  to  some  other 
purpose,  the  status  of  the  remainder  is  not  affected  provided  such  remain- 
der is  being  retained  to  apply  toward  the  purchase  of  a  principal  resi- 
dence. 

NOTE:  Authority  cited:  Sections  10725,  14006.1  and  14124.5,  Welfare  and  Jnsfi- 
tutions  Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 

1 .  Amendment  filed  12-15-77;  effective  thirtieth  day  thereafter  (Register  77,  No. 
51). 

2.  Amendment  filed  1 2-2-85  as  an  emergency;  effective  upon  filing  (Register  85, 
No.  50).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  4-1-86. 

3.  Certificate  of  Compliance  transmitted  to  OAL  3-31-86  and  filed  4-30-86 
(Register  86,  No.  18). 

§  50427.    Other  Real  Property. 

(a)  Real  property  not  exempt  as  a  principal  residence,  including  deeds 
of  trust  as  specified  in  Section  50441(b),  is  other  real  property. 

(b)  Other  real  property  not  exempt  under  any  other  section  of  these 
regulations  shall  be  exempt  if  both  of  the  following  conditions  are  met: 

(1)  The  combined  net  market  value  of  all  other  real  property  is  $6,000 
or  less. 

(2)  The  owner  meets  the  utilization  requirements  set  forth  in  Section 
50416. 

(c)  Other  real  property  with  a  net  market  value  of  more  than  $6,000 
shall  be  considered  as  follows: 

(1)  The  first  $6,000  of  net  market  value  shall  be  exempt  if  the  owner 
meets  the  utilization  requirements  set  forth  in  Section  50416. 

(2)  The  net  market  value  in  excess  of  $6,000  shall  be  included  in  the 

property  reserve. 

NOTE;  Authority  cited:  Sections  10725,  14006.1  and  14124.5,  Welfare  and  Insfi- 
tutions  Code;  Section  57(c),  Chapter  328,  Statutes  of  1982;  Section  87,  Chapter 


1594,  Statutes  of  1 982.  Reference:  Sections  1 1 153.7  and  14006,  Welfare  and  Insti- 
tutions Code. 

History 

1.  Amendment  filed  12-2-85  as  an  emergency;  effecfive  upon  filing  (Register  85, 
No.  50).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  4-1-86.  For  prior  history,  see 
Register  84,  No.  51. 

2.  Certificate  of  Compliance  transmitted  to  OAL  3-31-86  and  filed  4-30-86 
(Register  86,  No.  18). 


§  50428.    Liens. 

(a)  The  Department  shall  record  a  lien  against  the  ownership  interest 
in  the  principal  residence  of  an  institutionalized  beneficiary  if  the  proper- 
ty meets  the  provisions  of  Section  50425  (a)(7)  unless: 

(1)  The  individual  did  not  receive  a  Notice  of  Action  according  to  the 
provisions  of  Section  50179  or  has  not  had  the  opportunity  for  a  state 
hearing  according  to  the  provisions  of  Article  18  (commencing  with  Sec- 
tion 50951)  of  this  Chapter.  Such  Notice  shall  include  the  following: 

(A)  The  beneficiary  has  stated  he/she  does  not  intend  to  return  to  the 
principal  residence  from  long  term  care; 

(B)  A  lien  will  be  recorded  against  the  property  for  the  cost  of  all 
Medi-Cal  claims  paid  or  to  be  paid  on  the  beneficiary's  behalf. 

(C)  The  recording  of  the  lien  does  not  mean  ownership  of  the  property 
is  lost  or  transferred. 

(D)  The  requirements  to  list  the  property  for  sale  that  the  applicant  or 
beneficiary  must  meet  to  remain  eligible  for  Medi-Cal  in  accordance 
with  Section  50425. 

(E)  The  beneficiary  has  the  right  to  a  county  level  review  and  a  state 
hearing  prior  to  recording  of  the  lien  or  imposing  any  requirements  to  list 
the  property  for  sale. 

(F)  The  procedures  for  requesfing  a  county  level  review  and  the  time 
limits  within  which  such  requests  must  be  made. 

(b)  Any  recorded  lien  for  an  amount  equal  to  the  cost  of  medical  care 
provided  may  be  foreclosed  only  after  one  of  the  following: 

(1)  The  beneficiary  sells  the  property. 

(2)  The  beneficiary  dies  and  the  following  conditions  are  met: 

(A)  There  is  no  surviving  spouse. 

(B)  The  beneficiary  has  no  surviving  child  who  is  under  the  age  of  21 
or  who  is  blind  or  disabled. 

(c)  Any  lien  shall  dissolve  when  the  beneficiary  is  discharged  from 
LTC  and  returns  to  the  principal  residence  to  live. 

(d)  The  county  department  shall  notify  the  Department  upon  a  deter- 
mination that: 

(1)  All  the  criteria  set  forth  in  Section  50428(a)  are  met;  or 

(2)  A  person  in  long  term  care  has  been  discharged  and  has  returned 
to  the  principal  residence  to  live. 

NOTE:  Authority  cited:  Sections  10725, 14006.1  and  14124.5,  Welfare  and  Insfi- 
tutions  Code:  Section  57(c),  Chapter  328,  Statutes  of  1982;  and  Section  87,  Chap- 
ter 1594,  Statutes  of  1982.  Reference:  Section  14006,  Welfare  and  Institutions 
Code. 

History 

1.  New  section  filed  12-31-82  as  an  emergency;  effective  upon  filing  (Register 
83,  No.  2).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  4-30-83. 

2.  Certificate  ofCompHance  including  editorial  correction  of  subsection  (b)(1)(B) 
transmitted  to  OAL  4-29-83  and  filed  6-3-83  (Register  83,  No.  23). 

3.  Editorial  correction  of  subsection  (b)(1)(B)  refiled  7-6-83  (Register  83,  No. 

28). 

4.  Repealer  filed  7-24-84  as  an  emergency;  effecfive  upon  filing  (Register  84,  No. 
31).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  1 1-21-84. 

5 .  Order  of  Repeal  of  7-24-84  emergency  order  filed  1 2-20-84  by  OAL  pursuant 
to  Government  Code  Section  1 1349.6  (Register  84,  No.  51). 

6.  Amendment  filed  12-2-85  as  an  emergency;  effective  upon  filing  (Register  85, 
No.  50).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  4-1-86. 

)  and  filed  4-30-86 


7.  Certificate  of  Compliance  transmitted  to  OAL  3-31- 
(Register  86,  No.  18). 


Page  356 


Register  95,  No.  14;  4-7-95 


Title  22 


Health  Care  Services 


§  50433 


• 


§  50429.    Value  and  Division  of  Real  Property  Where  Part  Is 
Used  As  a  Home. 

NOTE:  Authority  cited:  Sections  10725, 14006.1  and  14124.5,  Welfare  and  Insti- 
tutions Code.  Reference:  Section  14006,  Welfai^e  and  Institutions  Code. 

History 

1 .  Repealer  filed  7-24-84  as  an  emergency;  effective  upon  filing  (Register  84,  No. 
31 ).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  11-21-84. 

2.  Order  of  Repeal  of  7-24-84  emergency  order  filed  12-20-84  by  OAL  pursuant 
to  Government  Code  Section  1 1349.6  (Register  84,  No.  51 ). 

3.  Repealer  filed  1 2-2-85  as  an  emergency;  effective  upon  filing  (Register  85,  No. 
50).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  4-1-86. 

4.  Certificate  of  Compliance  transmitted  to  OAL  3-31-86  and  filed  4-30-86 
(Register  86,  No.  18). 

§  50431 .     Land  Contiguous  to  the  Home — Value  and 
Division. 

NOTE:  Authority  cited:  Sections  10725, 14006.1  and  14124.5,  Welfare  and  Insd- 
tutions  Code.  Reference:  Secfion  14006,  Welfare  and  Institutions  Code. 


History 

1 .  Repealer  filed  7-24-84  as  an  emergency;  effective  upon  filing  (Register  84,  No. 
31).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  11-21-84. 

2.  Order  of  Repeal  of  7-24-84  emergency  order  filed  1 2-20-84  by  OAL  pursuant 
to  Government  Code  Section  1 1349.6  (Register  84,  No.  51). 

3.  Repealer  filed  1 2-2-85  as  an  emergency;  effective  upon  filing  (Register  85,  No. 
50).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  4-1-86. 

4.  Certificate  of  Compliance  transmitted  to  OAL  3-31-86  and  filed  4-30-86 
(Register  86,  No.  18). 

§  50433.    Single  Family  Dwelling  Used  in  Part  As  a 
Business — Value  and  Division. 

NOTE:  Authority  cited:  Sections  10725,  14006.1  and  14124.5,  Welfare  and  Insti- 
tufions  Code.  Reference:  Section  14006,  Welfare  and  Insfitutions  Code. 

History 
1 .  Repealer  filed  7-24-84  as  an  emergency;  effective  upon  filing  (Register  84,  No. 

31).  A  Certificate  of  Compliance  must  be  transinitted  to  OAL  within  120  days 

or  emergency  language  will  be  repealed  on  11-21-84. 


• 


[The  next  page  is  357.] 


• 


Page  356.1 


Register  95,  No.  14;  4-7-95 


Title  22 


Health  Care  Services 


§  50446 


• 


• 


2.  Order  of  Repeal  of  7-24-84  emergency  order  filed  12-20-84  by  OAL  pursuant 
to  Government  Code  Section  11349.6  (Register  84,  No.  51). 

3.  Repealer  filed  1 2-2-85  as  an  emergency;  effective  upon  filing  (Register  85,  No. 
50).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  4-1-86. 

4.  Certificate  of  Compliance  transmitted  to  OAL  3-31-86  and  filed  4-30-86 
(Register  86,  No.  18). 

§  50435.    Multiple  Dwelling  Unit — Value  and  Division. 

NOTE:  Authority  cited:  Sections  10725, 14006.1  and  14124.5,  Welfare  and  Insti- 
tutions Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 

1 .  Repealer  filed  7-24-84  as  an  emergency;  effective  upon  filing  (Register  84.  No. 
31).  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days  or 
emergency  language  will  be  repealed  on  1 1-21-84. 

2.  Order  of  Repeal  of  7-24-84  emergency  order  filed  1 2-20-84  by  OAL  pursuant 
to  Government  Code  Section  1 1 3^49 .6  (Register  84,  No.  51). 

3.  Repealer  fi  led  1 2-2-85  as  an  emergency;  effecdve  upon  filing  (Register  85,  No. 
50),  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  4-1-86. 

4.  Certificate  of  Compliance  transmitted  to  OAL  3-31-86  and  filed  4-30-86 
(Register  86,  No.  18). 

§  50437.     Land  with  More  Than  One  Building — Value  and 

Division. 

NOTE:  Authority  cited;  Secfions  10725,  14006.1  and  14124.5,  Welfare  and  Insti- 
tutions Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 

1.  Repealer  filed  7-24—84  as  an  emergency;  effecdve  upon  filing  (Register  84,  No. 
31).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  1 1-21-84. 

2.  Order  of  Repeal  of  7-24-84  emergency  order  filed  12-20-84  by  OAL  pursuant 
to  Government  Code  Section  1 1349.6  (Register  84,  No.  51). 

3.  Repealer  filed  12-2-85  as  an  emergency ;  effective  upon  filing  (Register  85,  No. 
50).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days 
or  emergency  language  will  be  repealed  on  4-1-86. 

4.  Certificate  of  Compliance  transmitted  to  OAL  3-31-86  and  filed  4-30-86 
(Register  86,  No.  18). 

§  50441 .    Mortgages,  Deeds  of  Trust  and  Other  Promissory 
Notes. 

(a)  Mortgages,  notes  secured  by  deeds  of  trust  and  other  promissory 
notes  which  can  be  sold  or  discounted  shall  be  included  in  the  property 
reserve,  except  as  specified  in  (b). 

(b)  A  mortgage,  or  a  note  secured  by  a  deed  of  trust,  from  the  sale  of 
real  property  owned  by  the  applicant  or  beneficiary  shall  be  considered 
other  real  property  and  subject  to  all  the  conditions  placed  upon  other  real 
property  in  these  regulations. 

(c)  The  market  value  of  all  mortgages  and  notes  shall  be  the  value  as 
established  in  (1),  unless  the  applicant  or  beneficiary  chooses  to  meet  the 
conditions  of  (2),  and  (2)  is  lower: 

(1)  The  principal  amount  remaining  on  the  note. 

(2)  The  appraised  value  obtained  by  the  applicant  or  beneficiary  from 
a  party  qualified  to  appraise  such  items.  Parties  qualified  to  appraise  such 
items  include,  but  are  not  limited  to,  any  of  the  following: 

(A)  Banks. 

(B)  Savings  and  Loan  Associations. 

(C)  Credit  Unions. 

(D)  Licensed  loan  or  mortgage  brokers. 

(d)  Proceeds  from  mortgages  and  notes  shall  be  considered  as  follows: 

(1)  The  principal  portion  of  the  payment  shall  be  treated  as  property. 

(2)  The  interest  portion  of  the  payment  shall  be  unearned  income  and 
shall  be  included  in  determining  the  share  of  cost. 

Note:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 

1.  New  section  filed  5-6-81;  effective  thirtieth  day  thereafter  (Register  81,  No. 
19).  For  prior  history,  see  Registers  81,  No.  15;  80,  No.  48;  77,  No.  51;  77,  No. 
17;and77,  No.  5. 

2.  Editorial  correcfion  of  NOTE  filed  1-21-83  (Register  83,  No.  4). 

§  50442.    Life  Estate. 

(a)  A  life  estate  interest  in  real  property  shall  be  considered  real  proper- 
ty- 


(b)  A  life  estate  interest  in  personal  property  shall  be  considered  per- 
sonal property. 

(c)  The  value  of  a  life  estate  shall  be: 

(1)  The  entire  market  value  of  the  property  on  which  the  life  estate  is 
held  if  the  applicant  or  beneficiary  was  the  owner  of  the  property  prior 
to  selling  the  property  and  he/she  is  retaining  a  life  estate  interest  in  the 
properly,  and  the  Life  estate  is  revocable,  or 

(2)  In  all  other  instances,  the  value  determined  in  accordance  with  the 
California  State  Gift  Inheritance  Tax  Formula  or,  at  the  applicant's  or 
beneficiary's  option,  a  lesser  value  established  by  a  person  qualified  to 
appraise  such  items  as  described  in  Section  50441  (c)  (2). 

NOTE:  Authority  cited:  Sections  10725  and  14124.5.  Welfare  and  Institutions 
Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code;  and  42  United 
States  Code  Section  1396a  (a)  (10)  (C). 

History 

1 .  Editorial  con-ection  adding  NOTE  filed  6-10-83  (Register  83,  No.  24). 

2.  Amendment  of  subsection  (c)  filed  5-17-89;  operative  6-16-89  (Register  89, 
No.  20). 

§  50443.    American  Indian's  Interest  in  Land  Held  in  Trust 
by  United  States  Government. 

The  entire  market  value  of  an  American  Indian's  interest  in  land  held 
in  trust  by  the  United  States  Government  shall  be  exempt. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institudons 
Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 

1.  Change  without  regulatory  effect  adding  NOTE  filed  10-11-88  (Register  88, 

No.  45). 

§  50445.    Federal  Payments  to  Indians  and  Alaskan 
Natives — Property. 

(a)  Payments  received  from  the  Federal  Government  under  Public 
Law  90-507  shall  be  excluded  from  consideration  as  personal  property 
when  the  total  of  nonexempt  personal  property,  including  such  payments 
does  not  exceed  $2,000  for  each  individual.  Payments  converted  into  oth- 
er property  shall  be  treated  the  same  as  the  payments.  However,  if  the 
property  received  through  such  a  conversion  is  again  converted,  the 
property  acquired  is  included  in  the  property  reserve  unless  otherwise  ex- 
empt. 

(b)  Payments  received  from  the  Federal  Government  under  Public 
Law  92-254  or  Section  6  of  Public  Law  87-775  shall  be  exempt. 

(c)  Per  capita  payments  distributed  pursuant  to  any  judgment  of  the  In- 
dian Claims  Commission  or  the  Court  of  Claims  in  favor  of  any  Indian 
Tribe  are  exempt. 

(d)  Shares  of  stock  and  money  payments  made  to  Alaskan  Nafives  un- 
der the  Alaskan  Native  Claims  Settlement  Act  are  exempt  as  long  as  the 
payments  or  stock  remain  separately  identifiable  and  not  comingled  with 
nonexempt  resources.  Any  property  obtained  from  stock  investments  un- 
der the  Act  is  not  exempt. 

(e)  Receipts  derived  from  lands,  as  specified  in  Section  50537(e),  shall 
be  exempt  providing  all  of  the  following  conditions  are  met.  The  monies: 

(1)  Are  retained  by  the  original  recipient. 

(2)  Are  not  commingled. 

(3)  Can  be  separately  identified  as  a  proportionate  share  of  the  appli- 
cant's or  beneficiary's  property. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Insdtutions 
Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 

1.  New  subsection  (e)  filed  as  an  emergency  6-17-80;  (Register  80,  No.  25).  A 
Certificate  of  Compliance  must  be  transmitted  to  OAL  within  1 20  days  or  emer- 
gency language  will  be  repealed  on  10-16-80. 

2.  Certificate  of  Compliance  filed  9-26-80  (Register  80,  No.  39). 

§  50446.    Payments  to  Victims  of  the  National  Socialist 
Persecution. 

(a)  Payments  received  from  the  Federal  Republic  of  Germany  (Ger- 
man Reparations  Payments)  pursuant  to  the  federal  law  on  the  Compen- 
sation of  Victims  of  the  National  SociaUst  Persecution  (Federal  Compen- 


Page  357 


Register  98,  No.  14;  4-3-98 


§  50448 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


sation  Law)  shall  be  exempt  from  consideration  as  personal  property  pro- 
vided these  funds  are  not  spent  and  are  kept  identifiable. 

(b)  If  the  funds  referred  to  in  subsection  (a)  have  been  spent,  the  prop- 
erly acquired  with  the  funds  shall  be  included  in  the  property  reserve  un- 
less otherwise  exempt. 

(c)  If  the  exempt  funds  referred  to  in  subsection  (a)  have  been  com- 
mingled with  nonexempt  funds,  it  is  the  applicant's  or  beneficiary's  re- 
sponsibility to  be  able  to  distinguish  which  are  the  exempt  commingled 
funds.  It  is  presumed  that  withdrawals  from  an  account  in  which  exempt 
and  nonexempt  funds  have  been  commingled  were  made  from  the  nonex- 
empt fund  first. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  1 4005.5  and  14006,  Welfare  and  Institutions  Code,  and 
Program  Operations  Manual  SI  01120.405. 

History 

1.  New  section  filed  9-4-91;  operative  10-4-91  (Register  92,  No.  2). 

2.  Editorial  correction  of  subsection  (c)  (Register  95,  No.  45). 

§  50448.    Payments  to  Victims  of  Crimes — Treatment  as 
Property. 

Payments  made  under  the  California  Victims  of  Crimes  program, 
which  are  exempt  as  income  in  the  month  of  receipt  in  accordance  with 
Section  50534,  shall  be  exempt  as  property  for  the  9-month  period  begin- 
ning after  the  month  in  which  the  payment  was  received. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  Sections  1383(a)(9),  1382b(a)  and  1396a(r),  Title  42,  United  States  Code. 
Reference:  Section  13959,  Government  Code;  Section  14006(c),  Welfare  and  In- 
stitutions Code. 

History 
1.  New  section  filed  lO^t-93;  operafive  1 1-3-93  (Register  93,  No.  41). 

§  50448.5.     Relocation  Assistance  Benefits. 

(a)  Relocation  assistance  benefits  are  payments  made  by  a  public 
agency  to  a  person  who  has  been  relocated  as  a  result  of  a  program  of  area 
redevelopment,  urban  renewal,  freeway  construction,  or  any  other  public 
development  involving  demolition  or  condemnation  of  existing  housing. 

(b)  Relocation  Assistance  Benefits  paid  by  a  public  agency  shall  be  ex- 
empt provided  these  these  funds  are  not  spent  and  are  kept  identifiable. 

(c)  If  the  exempt  funds  referred  to  in  subsection  (b)  have  been  com- 
mingled with  nonexempt  funds,  it  is  the  applicant's  or  beneficiary's  re- 
sponsibility to  be  able  to  distinguish  which  are  the  exempt  commingled 
funds.  It  is  presumed  that  withdrawals  from  an  account  in  which  exempt 
and  nonexempt  funds  have  been  commingled  were  made  from  the  nonex- 
empt funds  first. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  1396a(r)(2)  and  4636,  Title  42,  United  States  Code; 
Sections  14005.4, 14005.7  and  14006,  Welfare  and  Institutions  Code;  and  United 
States  Department  of  Health  and  Human  Services  Social  Security  Administration 
"Program  Operations  Manual  SI  00830.655,  SI  01130.670  and  SI  01130.700." 

History 
1.  New  section  filed  3-30-98;  operafive  4-29-98  (Register  98,  No.  14). 

§  50449.     Earned  Income  Tax  Credit. 

The  actual  Earned  Income  Tax  Credit  (EITC)  payment  or  an  advance 
payment  of  the  Earned  Income  Tax  Credit  made  by  an  employer  shall  be 
exempt  in  the  month  following  the  month  of  receipt. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Insfitufions 
Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code;  Sections  1612b, 
161 3a  and  1 902r(2),  Social  Security  Act  [42  U.S.C.  Secfions  1382a(b),  1382b(a), 
and  1396a(r)(2)]. 

History 

1.  New  secdon  filed  2-2-93;  operafive  3-4-93  (Register  93,  No.  6). 

§50451.     Cash  on  Hand. 

Cash  on  hand  shall  be  included  in  the  property  reserve,  unless  it  is  in- 
come received  in  that  month. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Insfitufions 
Code.  Reference:  Secfion  14006,  Welfare  and  Insfitufions  Code. 

History 

1.  Change  without  regulatory  effect  adding  NOTE  filed  10-1 1-88  (Register  88, 

No.  45). 


§  50453.    Checking  and  Savings  Accounts. 

(a)  The  enfire  amount  in  checking  and  savings  accounts  to  which  the 
applicant  or  beneficiary  has  unrestricted  access  shall  be  included  in  the 
property  reserve,  subject  to  the  limitations  in  Section  50453.5  and  the  fol- 
lowing conditions: 

(1)  Income  received  during  a  month  and  deposited  in  a  checking  or 
savings  account  shall  not  be  considered  as  property  during  that  month. 

(2)  Accounts  held  with  persons  who  are  not  family  members  shall  be 
considered  available  in  their  entirety  if  the  applicant  or  beneficiary  has 
unrestricted  access  to  the  funds,  unless  the  conditions  of  (3)  are  met. 

(3)  If  the  applicant  or  beneficiary  presents  evidence  which  clearly  esta- 
blishes that  all  or  a  portion  of  the  funds  specified  in  (2)  are  the  property 
of  a  person  who  is  not  a  family  member,  those  funds  shall  not  be  consid- 
ered the  property  of  the  applicant  or  beneficiary. 

(b)  If  an  applicant  or  beneficiary  has  restricted  access  to  a  checking  or 
savings  account  such  as  accounts  which  require  two  signatures  or  savings 
accounts  held  in  trust  by  other  than  the  applicant  or  beneficiary,  only 
those  funds  actually  available  shall  be  included  in  the  properl:y  reserve. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Insfitutions 
Code.  Reference:  Secfion  14006,  Welfare  and  Insfitufions  Code. 

History 
1.  Amendment  filed  3-7-80;  effecfive  thirtieth  day  thereafter  (Register  80,  No.  9). 

§  50453.5.    Savings  of  a  Child. 

Reasonable  amounts  saved  from  a  child's  exempt  earnings  for  future 
education  or  for  other  future  identifiable  needs  are  exempt  as  property. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Insfitufions 
Code.  Reference:  Section  14006,  Welfare  and  Institufions  Code. 

History 
1 .  New  secfion  filed  3-7-80;  effective  thirtieth  day  thereafter  (Register  80,  No.  9). 

§  50453.7.     Long-Term  Care  Insurance  Exemption. 

(a)  Property  shall  be  exempt  up  to  the  amount  of  benefits  that  have 
been  paid  for  Long-Term  Care  services  countable  towards  the  Medi-Cal 
property  exempfion  as  defined  in  Secdon  58023  in  behalf  of  the  Medi- 
Cal  applicant  or  Medi-Cal  beneficiary  under  a  cerfified  long-term  care 
insurance  policy  or  certificate  certified  by  the  State  to  provide  this  ex- 
emption. 

(b)  Property  exempted  under  subsection  (a)  shall  also  be  exempt  from 
any  recovery  by  the  State  of  payments  made  for  medical  services. 

(c)  Income  received  from  property  exempt  under  subsection  (a)  shall 
be  nonexempt  and  shall  be  treated  in  accordance  with  regulations  con- 
tained in  Article  10  of  Chapter  8. 

(d)  The  Medi-Cal  applicant  or  Medi-Cal  beneficiary  shall  provide 
verificafion  from  the  insurance  company  of  the  amount  of  qualified  bene- 
fits paid  which  entitle  that  applicant  or  beneficiary  to  an  exemption  under 
subsecfion  (a).  After  notifying  the  Department  in  accordance  with  Pro- 
bate Code,  Sections  215  and  9202,  the  person  handling  the  estate  of  a  de- 
ceased Medi-Cal  beneficiary  shall  also  provide  verification  to  the  De- 
partment from  the  insurance  company  of  the  amount  of  qualified  benefits 
paid  which  entitle  that  deceased  beneficiary  to  an  exemption  under  sub- 
secfion (b). 

(1)  If  the  verificafion  provided  by  the  insurance  company  is  found  to 
be  in  error  resulfing  in  the  ineligibility  of  the  Medi-Cal  applicant  or 
Medi-Cal  beneficiary,  the  County  shall  nofify  the  Department  to  take  ap- 
propriate actions  against  the  insurance  company  under  Secfion  58082(e). 

(2)  If  the  verificafion  provided  by  the  insurance  company  is  found  to 
be  in  such  a  condition  that  the  County  cannot  determine  whether  the 
Medi-Cal  applicant  or  Medi-Cal  beneficiary  is  entitled  to  an  exemption 
under  subsection  (a),  the  County  shall  determine  that  the  Medi-Cal  appli- 
cant or  Medi-Cal  beneficiary  is  not  enfitied  to  such  an  exempfion  and 
shall  nofify  the  Department  to  take  appropriate  actions  against  the  insur- 
ance company  under  Section  58082(f)  of  the  Partnership  Regulations  for 
Insurers. 

(3)  If  the  verification  provided  to  the  Department  by  the  person  handl- 
ing the  estate  of  a  deceased  beneficiary  is  found  to  be  either  in  error,  or 


Page  358 


Register  98,  No.  14;  4-3-9 


Title  22 


Health  Care  Services 


§  50459 


in  such  a  condilion  that  the  Department  cannot  determine  whether  the  de- 
ceased beneficiary  is  entitled  to  an  exemption  under  subsection  (b),  the 
Department  shall  take  appropriate  actions  against  the  insurance  company 
under  Section  58082(e)  and  (f). 

NOTE:  Authority  cited:  Section  22009(a),  Welfare  and  Institutions  Code.  Refer- 
ence: Sections  22004,  22005  and  22006,  Welfare  and  Institutions  Code. 

History 

1.  New  section  filed  11-1-93  as  an  emergency;  operative  1 1-1-93  (Register  93, 
No.  45).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  by  3-1-94 
or  emergency  language  will  be  repealed  by  operation  of  law  on  the  following 
day. 

2.  Certificate  ofCompliance  as  to  11-1-93  order  including  amendment  of  subsec- 
tion (d)(3)  transmitted  to  OAL  2-17-94  and  filed  3-31-94  (Register  94,  No. 
13). 

3.  Editorial  correction  of  printing  errors  in  subsections  (a),  (d)  and  (d)(2)  (Register 
94,  No.  13). 

§  50454.    Income  Tax  Refunds. 

Income  tax  refunds  shall  be  included  in  the  property  reserve. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14006,  Welfare  and  Institutions  Code. 

History 

1.  Editorial  correction  adding  NOTE  filed  6-10-83  (Register  83,  No.  24). 

§  50454.5.    California  Franchise  Tax  Board  Payments. 

(a)  The  following  payments  or  funds  received  from  the  California 
Franchise  Tax  Board  shall  be  exempt: 

(1)  Renters  Credits. 

(2)  Senior  Citizens  Homeowners  and  Renters  Property  Assistance. 

(3)  Senior  Citizens  Tax  Postponement. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Insdtufions 
Code,  Reference:  Section  11008.4,  Welfare  and  Institufions  Code. 

History 
1.  New  section  filed  4-17-89;  operative  5-17-89  (Register  89,  No.  48) . 

§  50455.    Lump  Sum  Payments. 

(a)  Nonrecurring  lump  sum  social  insurance  payments,  such  as  nonre- 
curring lump  sum  payments  of  any  of  the  items  specified  in  section 
50507(a)(1)  through  (9),  shall  be  included  in  the  property  reserve,  except 
as  provided  in  (b). 


(b)  Retroactive  SSI  and  Title  II  benefit  payments  shall  not  be  included 
in  the  property  reserve  for  a  period  of  six  months  after  the  month  in  which 
they  are  received. 

(c)  The  provisions  of  this  regulation  also  apply  to  eligibility  determi- 
nations or  redeterminations  made  retroactively  to  October  1.  1984. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4, 14005.7, 14005. Sand  14006,  Welfare  and  In- 
stitutions Code. 

History 

1.  Editorial  correction  adding  NOTE  filed  6-10-83  (Register  83,  No.  24). 

2.  Amendment  filed  4—15-85  as  an  emergency;  effective  upon  filing  (Register  85, 
No.  16).  A  Certificate  ofCompliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  8-13-85. 

3.  Certificate  ofCompliance  as  to  4-1 5-85  order  transmitted  to  OAL  8-1 3-85  and 
filed  9-18-85  (Register  85,  No.  38). 

4.  Change  without  regulatory  effect  amending  subsection  (a)  filed  6-14-91  pur- 
suant to  section  100,  title  1,  California  Code  of  Regulations  (Reeister  91,  No. 

35). 

§  50456.    Stocks,  Bonds,  Mutual  Funds. 

Stocks,  bonds  and  mutual  funds  shall  be  included  in  the  property  re- 
serve. The  value  of  these  items  shall  be  the  closing  price  on  the  date  the 
property  is  evaluated. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  InsUtutions 
Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 
1.  Change  without  regulatory  effect  adding  NOTE  filed  10-1 1-88  (Register  88, 

No.  45). 

§  50457.     United  States  Savings  Bonds. 

United  States  Savings  Bonds  shall  be  included  in  the  property  reserve. 
The  value  of  these  bonds  shall  be  the  amount  for  which  they  can  be  sold. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 
1.  Change  without  regulatory  effect  adding  NOTE  filed  10-1 1-88  (Register  88, 

No.  45). 

§  50459.     Promissory  Notes. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  InsUtutions 
Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 


• 


[The  next  page  is  359.] 


Page  358.1 


Register  98,  No.  14;  4-3-98 


Title  22 


Health  Care  Services 


§  50471 


• 


• 


History 

1 .  Amendment  filed  12-15-77;  effective  thirtieth  day  thereafter  (Register  77,  No. 
31). 

2.  Repealer  filed  1 1-26-80  as  an  emergency;  effective  upon  filing  (Register  80, 
No.  48).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  3-26-81. 

3.  Certificate  of  Compliance  transmitted  to  OAL  3-9-81  and  filed  4-7-81  (Regis- 
ter 81,  No.  15). 

§50461.    Motor  Vehicles. 

(a)  One  motor  or  other  vehicle  that  is  used  for  transportation  shall  be 
exempt,  subject  to  the  following  conditions: 

(1)  The  applicant  or  beneficiary  shall  be  allowed  to  choose  which  ve- 
hicle used  for  transportation  shall  be  exempt  except  that  recreational  and 
commercial  vehicles  shall  be  considered  to  be  used  for  transportation 
only  if  other  motor  vehicles  are  not  available  to  provide  transportation  for 
the  applicant  or  beneficiary. 

(2)  A  vehicle  owned  by  an  applicant  or  beneficiary  who  no  longer 
drives  shall  be  exempt  when  other  individuals  use  the  vehicle  to  meet  the 
transportation  needs  of  the  applicant  or  beneficiary. 

(b)  The  net  market  value  of  all  nonexempt  motor  vehicles  shall  be  in- 
cluded in  the  property  reserve. 

(c)  The  net  market  value  of  a  motor  vehicle  shall  be  determined  by  the 
following  process: 

(1)  Determine  the  class  of  the  motor  vehicle. 

(2)  Determine  the  vehicle  license  fee  which  does  not  include  registra- 
tion or  weight  fees,  using  the  class  and  the  State  Department  of  Motor  Ve- 
hicles license  fee  chart. 

(3)  Multiply  the  vehicle  license  fee  by  50.  This  is  the  market  value  of 
the  motor  vehicle. 

(4)  Subtract  any  encumbrances  of  record  from  the  market  value.  This 
is  the  net  market  value. 

(d)  In  those  cases  where  the  class  of  the  motor  vehicle  is  unknown  or 
unavailable,  the  county  department  or  the  applicant  or  beneficiary  shall 
contact  the  State  Department  of  Motor  Vehicles  to  determine  the  class  or 
license  fee  of  the  motor  vehicle. 

(e)  In  those  cases  where  the  applicant  or  beneficiary  does  not  agree 
with  the  net  market  value: 

(1)  Three  appraisals  by  auto  dealers,  insurance  adjustors  or  personal 
property  appraisers  shall  be  submitted  to  the  county  department. 

(2)  The  average  of  these  appraisals  shall  be  the  market  value. 

(3)  The  net  market  value  shall  be  the  market  value  minus  any  encum- 
brances of  record. 

NOTE;  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4  and  14005.7,  Welfare  and  Institutions  Code. 

History 

1.  Amendment  of  subsection  (d)and  new  subsection  (e)  filed  12-15-77;  effective 
thirtieth  day  thereafter  (Register  77,  No.  51). 

2.  Amendment  of  subsections  (a)(1)  and  (d)  filed  8-8-80;  effective  thirtieth  day 
thereafter  (Register  80,  No.  32). 

§  50463.    Boats,  Campers,  Trailers. 

(a)  The  net  market  value  of  boats,  campers,  and  trailers  and  mobile 
homes,  which  are  not  assessed  as  real  property  by  the  county  assessor, 
shall  be  included  in  the  property  reserve  unless  exempt  as  either  of  the 
following: 

(1)  A  principal  residence. 

(2)  A  vehicle  used  for  transportation. 

(b)  Items  in  (a)  which  are  assessed  as  real  property  by  the  county  asses- 
sor of  the  county  in  which  the  property  is  located  and  which  are  not  ex- 
empt as  a  home  shall  be  considered  as  other  real  property  and  treated  in 
accordance  with  Section  50427. 

(c)  The  net  market  value  of  these  items  shall  be  determined  as  follows: 
(1)  The  market  value  shall  be  any  of  the  following: 

(A)  The  average  of  three  appraisals  by  dealers,  insurance  adjustors  or 
personal  property  appraisers  submitted  to  the  county  department  by  the 
applicant  or  beneficiary. 

(B)  The  market  value  placed  on  the  item  by  the  county  assessor. 


(C)  The  market  value  of  the  item  determined  by  use  of  the  State  De- 
partment of  Motor  Vehicle's  license  fee  chart. 

(D)  The  original  purchase  price  of  the  item  if  the  applicant  or  benefi- 
ciary does  not  wish  or  is  unable  to  provide  three  appraisals  or  the  market 
value  cannot  be  determined  in  accordance  with  (B)  or  (C). 

(2)  The  net  market  value  shall  be  the  market  value  less  any  encum- 
brances of  record. 

(d)  Eligibility  or  share-of-cost  determinations  effective  on  or  after 
January  1,  1980,  shall  be  based  on  the  provisions  of  this  section. 
NOTE:  Authority  cited:  Sections  10725, 14006.1  and  14124.5,  Welfare  and  insti- 
tufions  Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 

1.  Amendment  of  subsection  (b)(1)  filed  1 2-1 5-77;  effective  thirtieth  day  thereaf- 
ter (Register  77,  No.  51). 

2.  Amendment  filed  3-7-80  as  an  emergency;  effective  upon  filing  (Register  80, 
No.  9).  A  Certificate  of  Compliance  must  be  transmitted  to  OAH  within  120 
days  or  emergency  language  will  be  repealed  on  7-6-80. 

3.  Certificate  of  Compliance  filed  6-6-80  (Register  80,  No.  23). 

4.  Amendment  of  subsection  (a)(  1 )  filed  1 2-2-85  as  an  emergency;  effective  upon 
filing  (Register  85,  No.  50).  A  Certificate  of  Compliance  must  be  transmitted 
to  OAL  within  120  days  or  emergency  language  will  be  repealed  on  4—1-86. 

5.  Certificate  of  Compliance  transmitted  to  OAL  3-31-86  and  filed  4-30-86 
(Register  86,  No.  1 8). 

§  50465.    Household  Items. 

All  items  used  to  furnish  and  equip  a  home  shall  be  exempt. 
NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 
1.  Editorial  con-ection  adding  NOTE  filed  6-10-83  (Register  83  No.  24). 

§  50467.     Personal  Effects. 

(a)  All  iteins  of  clothing  shall  be  exempt. 

(b)  The  following  jewelry  shall  be  exempt: 

(1)  Wedding  and  engagement  rings. 

(2)  Heirlooms. 

(3)  Any  other  item  of  jewelry  with  a  net  market  value  of  $100  or  less. 

(c)  The  net  market  value  of  jewelry  not  exempted  above  shall  be  in- 
cluded in  the  property  reserve. 

(d)  The  net  market  value  of  jewelry  shall  be  determined  as  follows: 

(1)  The  applicant  or  beneficiary  shall  submit  at  least  one  written  ap- 
praisal of  current  market  value  by  a  jeweler,  insurance  adjuster  or  person- 
al property  appraiser,  or  proof  of  the  purchase  price  in  the  form  of  a  sales 
slip  which  shall  estabhsh  the  market  value. 

(2)  Subtract  any  encumbrances  of  record  from  the  market  value.  This 
is  the  net  market  value. 

NOTE;  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code;  and  42  CFR 
435.851. 

History 

1.  Amendment  of  subsection  (d)  filed  8-18-82  as  an  emergency;  effective  upon 
filing  (Register  82,  No.  34).  A  Certificate  of  Compliance  must  be  transmitted 
to  OAL  within  120  days  or  emergency  language  will  be  repealed  on  12-16-82. 

2.  Certificate  of  Compliance  u-ansmitted  to  OAL  12-14-82  and  filed  1-21-83 
(Register  83,  No.  4). 

3.  Editorial  con-ecfion  of  NOTE  filed  6-10-83  (Register  83,  No.  24). 

4.  Amendment  of  subsection  (d)(1)  filed  10-24-86;  effective  thirtieth  day  thereaf- 
ter (Register  86,  No.  43). 

§  50469.    Recreational  Items. 

(a)  All  recreational  items  shall  be  exempt,  except  for: 

(1)  Recreational  motor  vehicles,  such  as  motor  homes  and  snowmo- 
biles, which  shall  be  considered  in  accordance  with  Section  50461. 

(2)  Boats,  campers  and  trailers,  which  shall  be  considered  in  accor- 
dance with  Section  50463. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 
1.  Editorial  correction  adding  NOTE  filed  6-10-83  (Register  83,  No.  24). 

§  50471.    Musical  Instruments. 

All  musical  instruments  shall  be  exempt. 


Page  359 


Register  97,  No.  15;  4-11-97 


§  50473 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 
I .  Editorial  correction  adding  NOTE  filed  6-10-83  (Register  83,  No.  24). 

§  50473.     Livestock  and  Poultry. 

(a)  Livestock  and  potiltry  retained  primarily  for  personal  use  shall  be 
exempt. 

(b)  The  net  market  value  of  livestock  and  poultry  retained  primarily 
for  profit  shall  be  included  in  the  property  reserve  except  to  the  extent  ex- 
empt as  business  property  in  accordance  with  Section  5)0485. 

(c)  The  net  market  value  of  livestock  and  poultry  shall  be  the  net  inar- 
ket  value  listed  by  the  applicant  or  beneficiary  on  the  Statement  of  Facts, 
unless  the  county  department  determines  further  verification  is  required. 
If  verification  is  required: 

(1)  The  applicant  or  beneficiary  shall  submit  three  appraisals  from  per- 
sons or  businesses  dealing  in  livestock  and  poultry.  The  average  of  these 
appraisals  shall  be  the  market  value. 

(2)  Subtract  any  encumbrances  of  record  from  the  market  value.  This 
is  the  net  market  value. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  12305  and  12305.5,  Welfare  and  Institutions  Code. 

History 

1.  Amendment  of  subsection  (b)  filed  5-17-79  as  an  emergency;  effective  upon 
filing  (Register  79,  No.  20). 

2.  Certificate  of  Compliance  filed  9-12-79  (Register  79,  No.  37). 

§  50475.    Life  Insurance. 

Life  insurance  policies,  except  term  insurance,  owned  by  a  member  of 
the  MFBU  on  the  life  of  any  individual  in  the  fainily  shall  be  exempt  if 
the  combined  face  value  of  all  of  the  policies  on  the  insured  individual 
is  $  1 ,500  or  less.  If  the  combined  face  value  of  all  of  the  policies  exceeds 
$1,500,  the  net  cash  surrender  value  of  life  insurance  policies  shall  be  in- 
cluded in  the  property  reserve. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 

1.  Amendment  filed  6-3-87;  operative  7-3-87  (Register  87,  No.  24). 

2.  Editoinal  correction  of  printing  error  (Register  89,  No.  16). 

§  50476.     Burial  Insurance. 

Burial  insurance  with  no  cash  surrender  value  shall  be  exempt.  Burial 
insurance  with  a  cash  .surrender  value  shall  be  considered  a  revocable 
burial  fund  and  shall  be  treated  as  provided  for  in  section  50479. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  11158,  12152  and  14006.  Welfare  and  Institutions 
Code;  and  Section  416.1231,  Title  20,  Code  of  Federal  Regulations. 

History 

1.  New  section  filed  3-7-80  as  an  emergency;  effective  upon  filing  (Register  80, 
No.  9).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  7-6-80. 

2.  Certificate  of  Compliance  filed  6-6-80  (Register  80,  No.  23). 

3.  Amendment  filed  5-29-91;  operafive  6-28-91  (Register  91,  No.  31). 

§  50477.     Burial  Plots,  Vaults  and  Crypts. 

(a)  Any  burial  plot,  vault  or  crypt  retained  by  the  applicant  or  benefi- 
ciary for  use  by  any  member  of  the  family  shall  be  exempt.  For  the  pur- 
poses of  this  section  only,  the  family  shall  include  the  applicant  or  benefi- 
ciary, his/her  spouse,  adult  or  minor  children  (including  adopted  and 
stepchildren),  siblings,  parents,  adoptive  parents,  and  the  spouses  of 
those  individuals. 

(b)  The  net  market  value  of  any  burial  plot  not  exempted  above  is  other 
real  property  and  shall  be  subject  to  all  conditions  placed  on  other  real 
property  in  these  regulations. 

(c)  The  net  market  value  of  any  burial  vault  or  crypt  not  exempted 
above  is  personal  property  and  shall  be  included  in  the  property  reserve. 

(d)  The  net  market  value  of  a  burial  plot,  vault  or  crypt  shall  be  the  net 
market  value  listed  by  the  applicant  or  beneficiary  on  the  Statement  of 
Facts,  unless  the  county  department  determines  further  verification  is  re- 
quired. If  verification  is  required: 

(1)  The  applicant  or  beneficiary  shall  submit  a  statement  of  value  from 
the  organization  from  which  the  plot,  vault  or  crypt  was  purchased.  This 
statement  of  value  shall  be  the  market  value. 


(2)  Subtract  encumbrances  of  record  from  the  market  value.  This  is  the 
net  market  value. 

NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  11158.  12152  and  14006,  Welfare  and  Institutions 
Code;  and  Section  416.1231,  Title  20,  Code  of  Federal  Regulations. 

History 

1 .  Editorial  corrections  adding  NOTE  filed  6-11-83  (Register  83,  No.  24). 

2.  Amendment  of  subsection  (a)  filed  .5-29-91 :  operative  6-28-91  (Register  91, 
No.  31). 

§  50479.     Burial  Funds. 

(a)  All  of  the  following  burial  funds  for  an  individual  shall  be  exempt. 

(1 )  Money  or  securities  placed  in  an  irrevocable  trust  for  funeral,  cre- 
mation, or  interment  expenses  with  the  following  trustees:  any  banking 
institution  or  trust  company  empowered  by  the  State  of  California  to  act 
as  trustee  in  the  handling  of  trust  funds,  cemetery  authority  which  has  es- 
tablished an  endowment  care  fund,  or  not  less  than  three  persons  one  of 
whom  may  be  in  the  employ  of  a  funeral  director. 

(2)  Money  or  securities  placed  in  an  irrevocable  trust  created  by  the 
deposit  in  an  insured  savings  institution  made  by  one  person  of  his  or  her 
own  money  in  his  or  her  own  name  as  trustee  for  a  funeral  director  to  pro- 
vide payment  for  funeral  services  rendered  by  the  funeral  director  upon 
the  depositor's  death. 

(3)  Life  or  burial  insurance  purchased  specifically  for  funeral,  crema- 
tion, or  interment  expense,  which  is  placed  in  an  irrevocable  trust  or 
which  has  no  loan  or  surrender  value  available  to  the  recipient. 

(4)  Securities  issued  by  a  licensed  ceinetery  authority  which  by  their 
terms  are  convertible  only  into  payment  for  funeral,  cremation,  or  inter- 
ment expenses. 

(b)  The  first  $1,500  paid  for  designated  burial  funds  for  funeral,  cre- 
mation or  interment  expenses  for  an  individual  shall  be  exempt  when  the 
fund  is  revocable. 

(c)  Designated  burial  funds  include  burial  trusts,  prepaid  burial  con- 
tracts, burial  insurance,  annuities  or  any  separately  identifiable  assets 
which  are  clearly  designated  as  set  aside  for  the  expenses  connected  with 
the  individual's  burial,  cremaUon,  or  other  funeral  arrangements. 

(d)  Interest  earned  on  or  appreciation  in  value  of  either  an  exempt  buri- 
al fund  described  in  subsection  (a),  above  or  revocable  designated  burial 
fund  described  in  subsections  (b)  and  (c),  above  shall  be  exempt  if  it  is 
left  to  accumulate  and  become  part  of  the  separately  identifiable  burial 
fund. 

(e)  The  amount  of  designated  burial  funds  which  are  not  exempt  shall 
be  included  in  the  property  reserve. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institufions 
Code.  Reference:  Secfions  11158  and  14006,  Welfare  and  InsUtufions  Code; 
Secfion  I396a(r)(2),  Title  42,  United  States  Code;  and  Secfions  416.1201  and 
416.1231,  Title  20,  Code  of  Federal  Regulafions. 

History 

1 .  Amendment  filed  3-7-80  as  an  emergency;  effective  upon  filing  (Register  80, 
No.  9).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  7-6-80. 

2.  Certificate  of  Compliance  filed  6-6-80  (Register  80,  No.  23). 

3.  Amendment  filed  5-29-91;  operafive  6-28-91  (Register  91,  No.  31). 

4.  Amendment  of  section  heading,  section  and  Note  filed  10-25-95;  operative 
1 1-24-95  (Register  95,  No.  43). 

§  50481 .    Disaster  and  Emergency  Assistance  Payments. 

Disaster  and  emergency  assistance  payments,  regardless  of  the  date  of 
receipt,  and  any  interest  eained  from  such  payments,  shall  be  permanent- 
ly exempt  and  shall  not  be  included  in  the  property  reserve.  This  exemp- 
tion applies  only  to  such  payments  received  from  federal,  state,  or  local 
government  agencies,  or  disaster  assistance  organizations. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Insfitutions 
Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code;  and  42  U.S.C. 
Sections  1382a(b)(ll)  and  (12),  1382b(a)(6),  1396a(a)(10),  5121  et  seq.  and 
5155(d). 

History 

1.  New  section  filed  10-5-93;  operative  1 1-4-93  (Register  93,  No.  41). 

2.  Editorial  correction  of  NOTE  (Register  97,  No.  15). 


Page  360 


Register  97,  No.  15;  4-11-97 


Title  22 


Health  Care  Services 


§  50489 


• 


§  50483.     Loans. 

(a)  Loans  shall  be  exempt  as  property  in  the  month  in  which  they  are 
any  of  the  following: 

(1)  Exempt  as  income  in  accordance  with  Section  50533. 

(2)  Treated  as  income  in  the  month  of  receipt  because  no  repayment 
is  required. 

(b)  Loans  which  require  repayment,  except  those  exempted  in  (a)(1), 
shall  be  included  in  the  property  reserve  beginning  in  the  month  of  re- 
ceipt. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14006,  Welfare  and  Institutions  Code. 

History 

1 .  Amendment  filed  9-17-79  as  an  emergency:  effective  upon  filing  (Register  79, 
No.  38).  A  Certificate  of  Compliance  must  be  filed  within  120  days  or  emergen- 
cy language  will  be  repealed  on  1-15-80. 

2.  Certificate  of  Comphance  transmitted  to  OAH  1-8-80  and  filed  1-16-80  (Reg- 
ister 80,  No.  3). 

§  50485.     Business  Property. 

(a)  Equipment,  inventory,  licenses  and  materials  owned  by  the  appli- 
cant or  beneficiary  which  are  necessary  for  employment,  for  self-support 
or  for  an  approved  plan  of  rehabilitation  or  self-care  necessary  for  em- 
ployment shall  be  exempt. 

(1)  Equipment,  inventory,  licenses  and  materials  shall  be  considered 
necessary  for  employment  if  either  of  the  following  conditions  is  met: 

(A)  The  applicant's  or  beneficiary's  employer  requires  that  the  appli- 
cant or  beneficiary  provide  this  property  as  a  condition  of  employment. 

(B)  The  applicant  or  beneficiary  is  currently  unemployed  but  has  been 
required  to  use  this  property  for  employment  in  the  past  and  can  provide 
reasonable  evidence  that  the  applicant  or  beneficiary  is  actively  seeking 
employment  which  will  require  the  use  of  the  same  property.  This  prop- 
erty shall  be  exempt  for  a  maximum  of  one  year  from  the  date  the  benefi- 
ciary became  unemployed  if  this  condition  is  met. 

(2)  Equipment,  inventory,  licenses  and  materials  shall  be  considered 
necessary  for  self-support  if  the  applicant  or  beneficiary  obtains  a  rea- 
sonable rate  of  return  from  the  use  of  this  property. 

(A)  A  business  or  means  of  self-support  that  has  been  in  existence  for 
more  than  one  year  shall  be  considered  to  be  realizing  a  reasonable  rate 
of  return  if  it  is  earning  an  annual  net  income  equal  to  six  percent  of  the 
net  market  value  of  the  property.  Net  income  shall  be  determined  in  ac- 
cordance with  Sections  50505  and  50517(a)(5). 

(B)  A  business  or  means  of  self-support  that  has  been  in  existence  for 
more  than  one  year  and  is  not  earning  net  income  equal  to  six  percent  of 
the  net  market  value  of  the  property  shall  be  considered  to  be  providing 
a  reasonable  rate  of  return  for  a  maximum  of  six  months  if  the  applicant 
or  beneficiary  can  show  by  objective  evidence  that  the  property  will  be- 
gin earning  six  percent  within  six  months. 

(C)  A  business  or  means  of  self-support  shall  not  be  required  to  realize 
any  actual  income  during  the  first  year  of  operation  in  order  to  meet  the 
requirement  for  realizing  a  reasonable  rate  of  return. 

(D)  A  business  or  means  of  self-support  that  has  been  in  existence  for 
more  than  one  year  and  is  resumed  after  an  illness,  or  a  period  of  con- 
valescence from  an  illness  or  injury,  shall  not  be  required  to  realize  any 
actual  income  during  the  first  six  months  of  resumed  operation  in  order 
to  meet  the  requirement  for  realizing  a  reasonable  rate  of  return. 

(E)  A  business  or  means  of  self-support  that  has  provided  the  appli- 
cant or  beneficiary  with  income  in  the  past  shall  be  considered  to  be  pro- 
viding a  reasonable  rate  of  return  for  a  maximum  of  one  year  during  a  pe- 
riod when  it  is  not  in  operation  if  the  applicant  or  beneficiary  can  provide 
evidence  that  both  of  the  following  conditions  are  met: 

1 .  The  business  or  means  of  self-support  is  not  in  operation  due  to  rea- 
sons beyond  the  applicant's  or  beneficiary's  control. 

2.  Operation  will  be  resumed  within  one  year  of  the  date  operation 
ceased. 

(3)  Equipment,  inventory,  licenses  and  materials  shall  be  considered 
necessary  for  an  approved  plan  of  rehabilitation  or  self-care  necessary 


for  employment  if  the  county  department  determines  that  the  property  is 
necessary  for  any  of  the  following: 

(A)  Training  which  will  lead  to  employment  or  self-support. 

(B)  Future  employment  or  a  means  of  self-support  that  will  result  from 
a  plan  of  rehabilitation  established  by  the  county  or  the  Department  of 
Rehabilitation. 

(C)  Employment  or  a  means  of  self-support  that  will  continue  after  a 
period  of  illness  or  a  period  of  convalescence  or  both. 

(b)  Motor  vehicles  shall  be  considered  equipment  only  if  used  for  em- 
ployment or  for  a  means  of  self-support  other  than  for  commuting  to  and 
from  work. 

(c)  Cash  on  hand  and  money  in  checking  accounts  necessary  for  the 
functioning  of  a  business  or  a  means  of  self-support  shall  be  exempt  up 
to  a  maximum  of  three  times  the  average  monthly  cash  expenditures  of 
the  business. 

(d)  Real  property  used  in  whole  or  in  part  as  a  business  or  as  a  means 
of  self-support  shall  be  considered  other  real  property  in  accordance  with 
Section  50427. 

(e)  Stocks,  bonds  and  other  similar  items  of  personal  property  shall  not 
be  considered  property  necessary  for  employment  or  self-support  even 
in  those  instances  where  the  beneficiary  holds  stock  in  the  corporation  in 
which  the  beneficiary  is  employed. 

(f)  A  person  who  owns  equipment,  inventory,  licenses  and  materials 
for  self-support  shall  not  be  required  to  be  personally  involved  in  the 
business  or  means  of  self-support  in  order  for  the  property  to  be  exempt 
under  (a). 

(g)  The  net  market  value  of  business  equipment,  inventory,  licenses 
and  materials  shall  be  the  amount  listed  by  the  applicant  or  beneficiary 
on  the  Statement  of  Facts,  unless  the  county  department  determines  that 
Sections  50442  through  50489  provide  a  method  of  valuing  the  specific 
item  of  property  or  that  further  verification  is  required. 

(1)  If  any  of  the  sections  between  Sections  50442  and  50489  can  be 
applied  as  a  method  of  valuing  the  specific  item  of  property  that  method 
shall  be  used. 

(2)  If  the  county  determines  that  further  verification  is  required  and 
Sections  50442  through  50489  do  not  apply: 

(A)  The  applicant  or  beneficiary  shall  submit  an  appraisal  from  an  ap- 
propriate dealer,  insurance  adjuster  or  personal  property  appraiser.  The 
value  listed  on  the  appraisal  shall  be  the  market  value. 

(B)  The  county  shall  subtract  encumbrances  of  record  from  the  market 
value.  This  is  the  net  market  value. 

NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  11 155, 12305,  12305.5,  and  14006,  Welfare  and  Insti- 
tutions Code. 

History 

1 .  Amendment  filed  5-17-79  as  an  emergency;  effective  upon  filing  (Register  79, 
No.  20). 

2.  Certificate  of  Compliance  filed  9-12-79  (Register  79,  No.  37). 

3.  Amendment  filed  1-16-80;  effective  thirtieth  day  thereafter  (Register  80,  No. 

3). 

§  50487.    Stocks  Held  by  Natives  of  Alaska. 

Shares  of  stock  in  a  regional  or  village  corporation  held  by  natives  of 
Alaska  for  a  20  year  period  during  which  such  stock  cannot  be  conveyed, 
transferred  or  surrendered,  shall  be  exempt. 

NOTE:  Authority  cited;  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  14006,  Welfare  and  InstituUons  Code. 

History 

1.  Editorial  correcfion  adding  Note  filed  6-1 1-83  (Register  83,  No.  24). 

§  50489.    Trusts— General. 

(a)  Property  and  income  held  in  trust  for  the  benefit  of  an  individual 
or  individual's  spouse  shall  be  treated  in  accordance  with  Sections  50489 
through  Section  50489.9.  These  sections  shall  supersede  any  other  sec- 
tion(s)  of  this  article. 

(b)  For  purposes  of  sections  50489  through  50489.9,  the  following 
definitions  apply: 


Page  361 


Register  98,  No.  5;  1-30-98 


§  50489.1 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


( J )  "Annuiiant"  means  a  person  who  has  the  right  to  receive  payments 
from  an  annuity.  The  annuity  shall  be  annuitized  based  upon  the  life  ex- 
pectancy of  the  annuitant. 

(2)  "Annuitized"  means  that  an  annuity  is  paying  a  fixed,  equal 
amount  to  the  annuitant  on  a  periodic  basis.  Payments  shall  be  no  less  fre- 
quent than  monthly  over  a  number  of  years  equal  to  or  less  than  the  annu- 
itant's  life  expectancy  as  indicated  in  life  expectancy  tables  provided  by 
the  Secretary  for  the  Department  of  Health  and  Human  Services,  con- 
tained in  Section  3258.9  (Revision  64),  Part  3  of  the  Health  Care  Financ- 
ing Administration's  State  Medicaid  Manual  and  titled  "Life  Expectancy 
Table — Males  and  Life  Expectancy  Table — Females".  The  final  annuity 
payment  may  be  for  an  amount  less  than  the  previously  fixed  annuity 
payments  in  order  to  fully  exhaust  benefits  under  the  annuity.  An  annuity 
shall  be  considered  annuitized  even  though  it  may  provide  an  annual  cost 
of  living  adjustment  equal  to  or  less  than  5%. 

(3)  "Annuity"  means  a  contract  to  make  periodic  payments  of  a  fixed 
or  variable  sum  paid  to  an  annuitant  which  are  payable  unconditionally. 
Annuity  payments  may  continue  for  a  fixed  period  of  time  or  for  as  long 
as  an  annuitant  lives.  An  annuitant  purchases  an  annuity  with  his  or  her 
property  or  property  rights.  Annuities  shall  be  established  to  provide  the 
annuitant  with  payments  representing  principal  and  interest  which  are 
more  than  the  fair  market  value  of  the  property  used  to  purchase  the  annu- 
ity. Annuities  purchased  prior  to  August  1 1,  1993,  other  periodic  pay- 
ment plans,  or  annuities  that  are  purchased  with  property  rights  belong- 
ing to  someone  other  than  the  Medi-Cal  applicant/beneficiary  or  spouse 
shall  continue  to  be  treated  in  accordance  with  Title  22,  Section  50402 
and  Article  10  of  this  chapter. 

(4)  "Assets"  shall  mean  all  income  and  property  of  the  individual  or 
the  individual's  spouse,  including  income  or  property  which  the  individ- 
ual or  spouse  is  entitled  to,  but  does  not  receive  because  of  circumstances 
brought  about  by: 

(A)  the  individual  or  the  individual's  spouse,  or 

(B)  any  other  individual  or  entity,  including  a  court  or  administrative 
body,  with  legal  authority  to  act  in  place  of,  or  on  behalf  of,  the  individual 
or  the  individual's  spouse,  or 

(C)  any  other  individual  or  entity,  including  any  court  or  administra- 
tive body,  acting  at  the  direction  or  upon  the  request  of  the  individual  or 
the  individual's  spouse. 

(5)  "Beneficiary"  means  any  individual  or  individuals  designated  in 
the  trust  instrument  as  benefiting  in  some  way  from  the  trust. 

(6)  "Date  of  establishment"  means  the  date  the  trust  document  (in  the 
case  of  a  trust),  annuity  purchase  agreement  (in  the  case  of  an  annuity), 
or  other  creating  document  (in  the  case  of  a  similar  legal  device)  is  signed 
and  dated.  A  trust  is  not  considered  to  be  established  on  the  date  it  has 
been  amended. 

(7)  "Irrevocable  trust"  means  a  trust  which  cannot  be  revoked  by  its 
own  terms  or  a  trust  deemed  to  be  irrevocable  under  State  law. 

(8)  "Revocable  trust"  means  a  trust  which  can  be  revoked  by  its  own 
terms  or  a  trust  deemed  to  be  revocable  under  State  law. 

(9)  "Similar  legal  device"  (SLD)  means  any  legal  instrument,  device 
or  arrangement  that  involves  the  transfer  of  assets  from  an  individual  or 
entity  (transferor)  to  another  individual  or  entity  (transferee)  with  the  in- 
tent that  the  assets  be  held,  managed,  or  administered  by  an  individual  or 
entity  for  the  benefit  of  the  transferor  or  certain  other  individuals.  SLDs 
also  include  annuities  purchased  on  or  after  August  II,  1993. 

(10)  "Trust"  means  any  arrangement  in  which  an  individual  or  entity 
(trustor)  transfers  assets  to  a  trustee  with  the  intent  that  the  assets  be  held, 
managed,  or  administered  by  the  trustee(s)  for  the  benefit  of  the  trustor 
or  certain  designated  individuals  (beneficiaries).  The  trust  must  be  valid 
under  State  law.  The  term  "trust"  also  includes  any  legal  instrument  or 
device  similar  to  a  trust  as  described  in  subsection  (b)(9)  of  this  section. 

(11)  "Trustee"  means  any  individual(s),  entity,  trust  advisory  commit- 
tee, or  individual(s)  with  power  of  appointment,  who  manages,  holds,  or 
administers  a  trust  for  the  trust  beneficiary  or  beneficiaries. 


( 1 2)  "Trustor"  means  an  individual  who  creates  a  trust.  A  trustor  is  also 
known  as  the  "settlor"  or  "grantor". 

(c)  For  purposes  of  this  article,  trusts  shall  be  classified  in  three  ways: 

(1)  Medicaid  Qualifying  Trusts  (MQT):  A  tmst  established  prior  to 
August  11.  1993,  as  described  in  Section  50489.1. 

(2)  OBRA  93  Trusts:  A  tmst  established  on  or  after  August  11,1 993 
as  described  in  Section  50489.5. 

(3)  Other  Trusts:  A  trust  other  than  those  described  in  subsections 
(c)(1)  or  (c)(2)  of  this  section. 

(d)  Placement  of  assets  in.  or  distributions  from,  a  trust  other  than  a 
burial  trust  which  is  exempt  pursuant  to  Section  50479  shall  be  consid- 
ered a  transfer  of  assets. 

(e)  Verification  of  trusts  shall  be  performed  by  the  county  in  accor- 
dance with  subsecUons  (e)(1)  and  (e)(2)  of  this  section. 

( 1)  A  written  trust  shall  be  verified  by  examining  the  trust  documents 
and  any  other  related  documents. 

(2)  An  oral  trust  shall  be  verified  by  written  affidavit  and  by  any  other 
related  documents.  Affidavits  shall  be  dated  and  signed  under  penalty  of 
perjury,  and  shall  specify  the  terms  of  the  oral  agreement.  Real  property 
cannot  be  held  in  an  oral  trust.  Oral  trusts  which  are  held  in  financial  insti- 
tufions  are  subject  to  Section  50402. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.7,  14006  and  14015(a),  Welfare  and  Institutions 
Code;  and  Sections  1396a(r)(2)(A)  and  ]396p(c),  (d)  and  (e),  Title  42.  United 
States  Code. 

HtSTORY 

1 .  Repealer  and  new  section  filed  4-6-94;  operative  5-6-94  (Register  94,  No.  1 4). 
For  prior  history,  see  Register  87,  No.  30. 

2.  Repealer  and  new  section  filed  1-28-98;  operative  1-28-98  pursuant  to  Gov- 
ernment Code  section  1 1343.4(d)  (Register  98,  No.  5). 

§  50489.1 .    Medicaid  Qualifying  Trusts. 

(a)  Pursuant  to  Title  42,  U.S.C,  Secdon  1 396a(k)  as  it  existed  prior  to 
repeal,  a  Medicaid  Qualifying  Trust  (MQT): 

(1)  Is  one  which  was  established  prior  to  August  11, 1993,  other  than 
by  will,  by  an  individual  or  the  individual's  spouse,  or  by  the  individual's 
guardian,  conservator,  or  legal  representative  who  is  acting  on  the  indi- 
vidual's behalf;  and  which 

(2)  Provides  that  the  individual  or  the  spouse  may  receive  all  or  part 
of  the  income  or  principal  of  the  trust  that  is  dispersed  directly  or  to  anoth- 
er person  or  enfity  on  behalf  of  that  individual;  and  which 

(3)  Gives  the  trustee(s)  discretion  in  distributing  funds  to  the  individu- 
al, to  the  spouse,  or  to  another  person  or  enfity  on  behalf  of  that  individu- 
al; and 

(4)  Is  not  described  in  Secfion  50489.9,  and 

(5)  May  be  revocable  or  irrevocable,  and 

(6)  May  be  established  to  enable  the  individual  or  the  spouse  to  qualify 
for  Medi-Cal. 

(b)  For  purposes  of  this  section,  "individual"  means  a  person  or  spouse 
who  establishes  an  MQT  and  who  is  a  beneficiary  of  the  MQT. 

(c)  Property  in  an  MQT  is  available  as  specified  below: 

(1)  If  the  MQT  is  revocable,  it  shall  be  available. 

(2)  If  the  MQT  is  irrevocable  then: 

(A)  Any  amount  distributed  from  the  principal  of  the  MQT  to  the  indi- 
vidual, to  the  spouse,  or  to  another  person  or  entity  on  behalf  of  that  indi- 
vidual or  spouse  shall  be  available  property. 

(B)  Any  amount  distributed  from  the  income  of  the  MQT  to  the  indi- 
vidual, to  the  spouse,  or  to  another  person  or  entity  on  behalf  of  that  indi- 
vidual or  spouse  shall  be  considered  income  and  shall  be  subject  to  Ar- 
ficle  1 0  of  this  chapter. 

(C)  The  maximum  amount  that  the  trustee(s)  could  distribute  to  the  in- 
dividual, to  the  spouse,  or  to  another  person  or  enfity  on  behalf  of  that  in- 
dividual or  spouse  from  trust  principal  shall  be  considered  available 
property.  The  maximum  amount  is  the  amount  the  trustee(s)  may  distrib- 
ute if  the  trustee(s)  were  to  exercise  full  discrefion  under  l:he  terms  of  the 
MQT. 


Page  362 


Register  98,  No.  5;  1-30-98 


Title  22 


Health  Care  Services 


§  50489.5 


• 


(D)  The  maximum  amount  that  the  taistee(s)  may  distribute  to  the  in- 
dividual, to  the  spouse,  or  to  another  person  or  entity  on  behalf  of"  that  in- 
dividual or  spouse  from  taist  income  if  the  trustee(s)  were  to  exercise  full 
discretion  under  the  terms  of  the  MQT  is  available  income  and  is  subject 
to  Article  10  of  this  chapter. 

(E)  Any  amount  of  trust  principal  for  which  the  trustee(s)  has  no  dis- 
cretion to  release  to  the  individual,  to  the  spouse,  or  to  another  person  or 
entity  on  behalf  of  that  individual  or  spouse  shall  be  considered  trans- 
ferred property.  The  date  of  the  transfer  shall  be  the  date  the  trust  was  es- 
tablished, the  date  the  trust  receives  the  property,  or  the  date  disburse- 
ment is  foreclosed,  whichever  is  the  most  recent. 

(F)  Any  amount  of  trust  income  for  which  the  trustee(s)  has  no  discre- 
tion to  release  to  the  individual,  to  the  spouse,  or  to  another  person  or  enti- 
ty on  behalf  of  that  individual  or  spouse  shall  be  considered  transferred 
assets.  The  date  of  the  transfer  shall  be  the  date  trust  disbursement  is  fore- 
closed, or  the  date  the  trust  recei  ves  income,  whichever  is  the  most  recent. 
Transfers  of  income  occurring  prior  to  August  11,1 993,  shall  not  be  con- 
sidered. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.7,  14006  and  1401 5(a),  Welfare  and  Institutions 
Code;  and  Sections  1 396a(r)(2)( A)  and  1396p(c),  (d)  and  (e).  Title  42,  United 
States  Code. 

History 
1.  New  section  filed  1-28-98;  operative  1-28-98  pursuant  to  Government  Code 
section  11343.4(d)  (Register  98,  No.  5). 

§  50489.5.    OBRA  93  Trusts  Established  On  or  After  August 
11,1993. 

(a)  An  OBRA  93  trust: 

(1)  Is  established,  in  part  or  in  whole,  with  assets  of  an  individual  or 
individual's  spouse,  on  or  after  August  1 1 ,  1993,  other  than  by  will;  and 

(2)  Is  not  described  in  Section  50489.9,  and 

(3)  Shall  be  treated  in  accordance  with  the  remainder  of  this  section. 

(b)  The  provisions  of  this  section  shall  apply  to  OBRA  93  trusts  with- 
out regard  to: 

(1)  the  purposes  for  which  the  trust  is  established, 

(2)  whether  the  trustee(s)  has,  or  exercises,  any  discretion  under  the 
terms  of  the  trust, 

(3)  restrictions  on  when,  or  whether,  distributions  may  be  made  from 
the  trust,  or 

(4)  restrictions  on  the  use  of  trust  assets  or  distributions. 

(c)  The  provisions  of  this  section  shall  apply  to  any  OBRA  93  trust  if 
it  was  established  by  any  of  the  following: 

(1)  the  individual,  or 

(2)  the  individual's  spouse,  or 

(3)  any  other  person  or  entity,  including  a  court  or  administrative  body, 
with  legal  authority  to  act  in  place  of,  or  on  behalf  of,  the  individual  or 
the  individual' s  spouse,  regardless  of  whether  that  person  or  entity  claims 
to  be  acting  in  such  a  capacity  at  the  time  of  the  action,  or 

(4)  any  other  person  or  entity,  including  any  court  or  administrative 
body,  acting  at  the  direction,  or  upon  the  request  of,  the  individual  or  the 
individual's  spouse. 

(d)  In  the  case  of  an  OBRA  93  trust  which  includes  the  assets  of  some- 
one other  than  the  individual  or  the  individual's  spouse,  the  provisions 
of  this  section  shall  apply  only  to  that  portion  of  the  trust  containing  the 
assets  of  the  individual  or  the  individual's  spouse. 

(e)  In  the  case  of  a  revocable  OBRA  93  trust: 

(1)  trust  income  and  principal  shall  be  considered  property  available 
to  the  individual  who  has  the  right,  power,  and  authority  to  revoke  the 
trust  and  to  use  the  proceeds,  and 

(2)  payments  from  the  trust  to,  or  for  the  benefit  of,  the  individual  or 
spouse  shall  be  considered  income  of  that  individual  or  spouse  in  accor- 
dance with  Article  10  of  this  chapter,  and 

(3)  if  payments  are  made  to  any  person  or  entity,  other  than  the  individ- 
ual or  spouse,  for  any  purpose  other  than  for  the  benefit  of  the  individual 
or  spouse,  those  payments  shall  be  considered  transferred  assets  as  of  the 
date  of  payment. 


(f)  In  the  case  of  an  irrevocable  OBRA  93  taist: 

(1)  if  payment(s)  can  be  made  from  the  trust  to,  or  for  the  benefit  of, 
the  individual  or  spouse  at  any  time  or  under  any  circumstances,  the  por- 
tion of  the  trust  income  or  principal  from  which  payment(s)  to  the  indi- 
vidual or  spouse  could  be  made  shall  be  considered  property  available  to 
that  individual  or  spouse, 

(2)  if  payment(s)  from  the  trust  income  or  principal  is  made  to,  or  for 
the  benefit  of,  the  individual  or  spouse,  the  payment(s)  shall  be  consid- 
ered income  of  that  individual  or  spouse,  in  accordance  with  Article  10 
of  this  chapter, 

(3)  if  payment(s)  is  made  from  the  trust  income  or  principal  for  any 
other  purpose,  the  payment(s)  shall  be  considered  a  transfer  of  assets  by 
the  individual  or  spouse  as  of  the  date  of  payment,  and 

(4)  if  any  portion  of  the  trust  income  or  principal  from  which  payment 
cannot  be  made  to,  or  for  the  benefit  of,  the  individual  or  spouse,  then  that 
portion  shall  be  considered  a  transferred  asset.  The  value  of  the  assets 
transferred  shall  include  the  amount  of  assets  used  to  establish  the  trust 
and  any  assets  added  to  that  portion.  Payments  which  have  been  made 
from  that  portion  of  the  trust  shall  not  be  deducted  from  the  value  of  the 
assets  transferred.  The  date  of  transfer  shall  be  the  date  the  trust  was  es- 
tablished, the  date  the  trust  receives  the  asset  or  the  date  disbursement  is 
foreclosed,  whichever  is  most  recent. 

(g)  In  the  case  of  an  annuity: 

(1)  Payments  shall  be  considered  income  in  accordance  with  Article 
10  of  this  chapter,  and 

(2)  Section  50402  shall  apply  only  to  the  extent  that  it  is  not  inconsis- 
tent with  subsections  (g)(2)(A)-(g)(2)(D)  of  this  section. 

(A)  The  undistributed  balance  of  the  annuity  shall  be  considered  un- 
available if  the  annuity  contract  is  annuitized  upon  the  life  expectancy  of 
the  individual  or  spouse  or  for  a  shorter  period  of  time. 

(B)  The  life  expectancy  of  the  annuitant  shall  be  determined  in  accor- 
dance with  life  expectancy  tables  specified  by  the  Secretary  of  the  De- 
partment of  Health  and  Human  Services,  contained  in  Section  3258.9 
(Revision  64),  Part  3  ofthe  Health  Care  Financing  Administration's  State 
Medicaid  Manual  and  titled  "Life  Expectancy  Table — Males  and  Life 
Expectancy  Table — Females". 

(C)  Any  payment  scheduled  to  occur  beyond  the  life  expectancy  ofthe 
individual  or  spouse  as  determined  in  accordance  with  subsection 
(g)(2)(B)  of  this  section  shall  be  considered  a  transfer  of  assets. 

(D)  Any  payment  made  to,  or  set  aside  for,  another  individual  (other 
than  for  the  sole  benefit  of  the  spouse),  shall  be  considered  a  transfer  of 
assets. 

(h)  The  county  must  consider  whether  undue  hardship  exists  before 
eligibility  may  be  denied  under  this  section.  Eligibility  shall  not  be  de- 
nied based  upon  the  provisions  of  this  section  if  undue  hardship  is  found 
to  exist.  The  provisions  of  this  section  shall  be  waived  if  the  application 
of  these  provisions  would  work  an  undue  hardship.  If  undue  hardship,  in 
accordance  with  the  provisions  of  this  subsection,  is  considered  and 
found  not  to  apply,  the  county  shall  state  that  on  the  notice  of  action.  For 
purposes  of  this  section,  undue  hardship  exists  when  all  ofthe  conditions 
in  subsections  (h)(1)  through  (h)(4)  of  this  section  exist  or  when  the  con- 
ditions in  subsections  (h)(5)  or  (h)(6)  of  this  section  exists.  The  county 
shall  notify  the  individual  that  undue  hardship  is  being  considered  prior 
to  denying  eligibility  to  any  individual  under  this  section. 

(1)  The  trust  assets  cannot,  under  any  circumstances,  be  used  to  pro- 
vide for  the  health  care  or  medical  needs  of  the  Medi-Cal  applicant  or 
Medi-Cal  beneficiary,  and 

(2)  Health  care  cannot  be  obtained  from,  and  medical  needs  cannot  be 
met  by,  any  source  other  than  Medi-Cal  without  depriving  the  individual 
of  food,  clothing  or  shelter  or  other  necessities  of  life,  and 

(3)  The  individual's  parents  (if  the  individual  is  under  21)  or  the  indi- 
vidual's spouse,  cannot  provide  for  the  health  care  and  medical  needs  or 
health  care  coverage  of  the  individual  without  depriving  themselves  of 
food,  clothing  or  shelter  or  other  necessities  of  life,  and 


Page  362.1 


Register  98,  No.  5;  1-30-98 


§  50489.9 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


(4)  The  courts  have  denied  a  good  faith  petition  to  release  the  trust  as- 
sets to  pay  for  the  required  medical  care. 

(A)  A  petition  to  release  the  trust  assets  shall  not  be  considered  a  vahd 
good  faith  petition  if  the  petition  contains  language  which  suggests  or  re- 
quests that  the  courts  do  anything  other  than  release  the  trust  assets  need- 
ed to  pay  for  the  required  medical  care. 

(B)  The  counties  shall  verify  that  the  criteria  contained  in  subsections 
(h)(4)  and  (h)(4)(A)  of  this  section,  concerning  a  valid  good  faith  petition 
and  court  order  exist  by  examining  the  petition  and  the  court  order. 

(C)  Subsection  (h)(4)  of  this  section  does  not  apply  to  an  annuity. 

(5)  No  person  shall  be  made  ineligible  to  the  extent  the  trust  contains 
otherwise  exempt  income  or  property. 

(6)  No  person  shall  be  made  ineligible  due  to  the  application  of  subsec- 
tion (g)  of  this  section,  concerning  an  annuity  purchased  prior  to  March 
1, 1996  when  the  annuity  cannot  be  annuitized  to  comply  with  the  provi- 
sions of  subsection  (g)  of  this  section.  Any  annuity  purchased  prior  to 
March  1 ,  1996  which  cannot  be  annuitized  to  comply  with  the  provisions 
of  subsection  (g)  of  this  section,  shall  continue  to  be  considered  in  accor- 
dance with  Section  50402. 

NOTE:  Authority  cited:  Sections  10725  and  14124.3,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.7,  14006  and  14015(a),  Welfare  and  institutions 
Code;  and  Sections  1396a(r)(2)(A)  and  1396p(c),  (d)  and  (e),  Title  42,  United 
Stales  Code. 

History 
1.  New  section  filed  1-28-98;  operative  1-28-98  pursuant  to  Government  Code 
section  1 1343.4(d)  (Register  98,  No.  5). 

§  50489.9.    Trusts  Other  than  Those  Described  in  50489.1 
or  50489.5. 

(a)  Trusts  described  in  subsections  (a)(1)  through  (a)(4)  of  this  section, 
shall  be  considered  available  in  accordance  with  subsection  (b)  of  this 
section: 

(1)  Trusts  that  are  not  described  in  Section  50489.1  or  Section 
50489.5. 

(2)  Any  trust  established  prior  to  April  7, 1 986,  which  benefits  no  one 
other  than  a  mentally  retarded  person  who  resides  in  an  intermediate  care 
facility  for  the  mentally  retarded. 

(3)  A  trust  established  on  or  after  August  1 1 ,  1993,  which  meets  all  of 
the  following  conditions: 

(A)  A  trust,  or  portion  of  a  trust,  that  contains  the  assets  of  an  individual 
or  spouse  who  was  both  disabled  as  verified  in  accordance  with  Section 
50167(a)(l )  and  under  the  age  of  65  when  the  trust  was  estabUshed  and 
who  is  currently  disabled  whether  or  not  he/she  is  age  65  or  over,  and 

(B)  A  trust  that  is  established  for  the  benefit  of  the  disabled  individual 
or  disabled  spouse  in  subsection  (a)(1)(A)  of  this  section  by  a  parent, 
grandparent,  legal  guardian  of  the  individual,  or  a  court,  and  where 

(C)  The  State  receives  all  remaining  funds  in  the  trust,  or  respective 
portion  of  the  trust,  upon  the  death  of  the  individual  or  spouse  or  upon 
termination  of  the  trust  up  to  an  amount  equal  to  the  total  medical  assis- 
tance paid  on  behalf  of  that  individual  by  the  Medi-Cal  program.  A  trust, 
or  respective  portion  of  the  trust,  will  stiU  be  considered  for  the  benefit 
of  the  individual  or  spouse  if  the  trust  permits  funds  to  be  used  for  other 
purposes  when  the  trust's  terms  permit  such  use  only  after  payment  of  the 
State's  interest  pursuant  to  this  subsection. 

(4)  A  trust  established  on  or  after  August  1 1, 1993,  which  meets  all  the 
conditions  listed  in  subsections  (a)(4)(A)  through  (a)(4)(F)  of  this  sec- 
tion: 

(A)  the  trust  contains  the  assets  of  the  individual  or  spouse  who  is  dis- 
abled as  verified  in  accordance  with  Section  50167(a)(1),  and 

(B)  the  trust  is  established  and  managed  by  a  nonprofit  association, 
and 

(C)  a  separate  account  is  maintained  for  each  trust  beneficiary,  but  for 
purposes  of  investment  and  management  of  funds,  the  trust  pools  these 
accounts,  and 

(D)  the  accounts  in  the  trust  are  established,  except  for  purposes  of 
subsection  (a)(4)(E)  of  this  section,  solely  for  the  benefit  of  the  disabled 
individual  or  disabled  spouse,  as  defined  in  subsection  (a)(4)(F)  of  this 
section,  by  the  disabled  individual  or  disabled  spouse,  his  or  her  parents, 
his  or  her  grandparents,  or  the  legal  guardian  of  that  individual,  or  by  a 


court,  and 

(E)  the  State  receives,  upon  the  death  of  the  disabled  individual  or  dis- 
abled spouse,  all  funds  remaining  in  the  individual's  account,  up  to  an 
amount  equal  to  the  total  amount  of  medical  assistance  paid  on  behalf  of 
that  individual  by  the  Medi-Cal  program.  The  State  shall  receive  this 
amount  only  to  the  extent  that  funds  remain  in  that  individual's  account 
and  are  not  retained  by  the  trust  to  cover  management  and  investment 
fees  associated  with  that  account. 

(F)  In  determining  whether  an  account  may  be  considered  solely  for 
the  benefit  of  the  disabled  individual  or  disabled  spouse,  both  subsections 
(a)(4)(F)(l)  and  (a)(4)(F)(2)  of  this  section  shall  apply. 

(1)  Except  in  accordance  with  subsection  (a)(4)(E)  of  this  section,  the 
account  funds  must  benefit  no  one  other  than  the  disabled  individual  or 
disabled  spouse  for  whose  benefit  the  account  was  established  before  the 
State's  interest  has  been  satisfied  pursuant  to  subsection  (a)(4)(E)  of  this 
section. 

(2)  If  the  trust  permits  funds  to  be  used  for  any  purpose  other  than  for 
the  sole  benefit  of  the  disabled  individual  or  disabled  spouse  for  whose 
benefit  the  trust  or  account  was  established,  before  the  State's  interest  has 
been  satisfied  pursuant  to  subsection  (a)(4)(E)  of  this  section,  the  account 
will  not  be  considered  solely  for  the  benefit  of  that  individual  or  spouse. 
Such  accounts  shall  be  treated  pursuant  to  Section  50489.5.  An  account 
will  still  be  considered  for  the  sole  benefit  of  the  individual  or  spouse  if 
the  trust  permits  funds  to  be  used  for  other  purposes  v/hen  the  trust's 
terms  permit  such  use  only  after  payment  of  the  State's  interest  pursuant 
to  subsection  (a)(4)(E)  of  this  section. 

(b)  Trusts  described  in  subsections  (a)(1)  of  this  section  through  (a)(4) 
of  this  section,  shall  be  considered  available  as  specified  in  subsections 
(b)(1)  and  (b)(2)  of  this  section. 

(1)  If  the  trust  is  revocable,  trust  income  and  principal  shall  be  consid- 
ered available  to  the  person  who  has  the  right,  power,  and  authority  to  re- 
voke the  trust  and  to  use  the  proceeds. 

(A)  Trust  income  is  income,  and  is  subject  to  Article  10  of  this  chapter. 
If  trust  income  is  not  distributed  in  the  month  of  receipt,  it  is  available 
property. 

(B)  Trust  principal  is  available  property. 

(2)  If  the  trust  is  irrevocable,  the  trust  assets  are  not  available  until  dis- 
tributed. 

(c)  Any  augmentations  or  additions  made  to  a  trust  described  in  sub- 
section (a)(3)  of  this  section  or  subsection  (a)(4)  of  this  section  after  the 
disabled  individual  or  disabled  spouse  for  whose  benefit  the  trust  was  es- 
tablished reaches  the  age  of  65  shall  be  considered  a  transfer  of  assets  for 
less  than  adequate  consideration;  earlier  augmentations  or  additions  shall 
not  be  considered  transferred  for  less  than  adequate  consideration. 

(d)  In  the  case  of  a  trust  described  in  subsection  (a)(3)  of  this  section 
or  (a)(4)  of  this  section,  to  ensure  that  the  Department  recovers  the  costs 
of  medical  care  it  provided,  the  Department's  Third  Party  Liability 
Branch  shall  be  notified 

(1)  by  the  county,  whenever  the  county  becomes  aware  of  a  Medi-Cal 
applicant  or  Medi-Cal  beneficiary  who  is  a  trust  beneficiary,  and 

(2)  by  the  trustee,  upon  death  of  the  trust  beneficiary,  termination  of 
the  trust,  or  change  of  trustee. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.7,  14006  and  14015(a),  Welfareandlnstitutions 
Code;  and  Sections  1396a(r)(2)(A)  and  1396p(c),  (d)  and  (e).  Title  42,  United 
States  Code. 

History 
1.  New  section  filed  1-28-98;  operative  1-28-98  pursuant  to  Government  Code 
section  11343.4(d)  (Register  98,  No.  5). 

Article  10.     Income 

§50501.    Income — General. 

(a)  Income  includes  benefits  in  cash  or  in  kind  from: 

(1)  Labor. 

(2)  Services  provided. 

(3)  Business  activities. 

(4)  Returns  from  real  or  personal  property. 


Page  362.2 


Register98,  No.  5;l-30- 


Title  22 


Health  Care  Services 


§  50507 


• 


• 


(5)  Contributions. 

(6)  Other  similar  sources. 

(b)  Income  from  sources  listed  in  (a)  shall  be  considered  as  income 
only  if  it  is  currently  available  in  accordance  with  Sections  50513 
through  50517. 

(c)  Income  from  sources  listed  in  (a)  shall  be  divided  into  three  types: 

(1)  Gross  earned  income  as  described  in  Section  50503. 

(2)  Gross  unearned  income  as  described  in  Section  50507. 

(3)  Income  in  kind  as  described  in  Section  50509. 

NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4,  14005.7, 14005.9  and  14005.12,  Welfare  and 
Institutions  Code. 

History 
1.  Editorial  coirection  adding  Note  filed  6-10-83  (Register  83,  No.  24). 

§  50503.    Gross  Earned  Income. 

(a)  Gross  earned  income  includes: 

(1)  Wages,  including  amounts  designated  for  meals  provided  by  an 
employer  or  business  enterprise,  salaries,  bonuses  and  commissions 
from  an  employer  or  business  enterprise. 

(2)  Net  profits  from  self-employment  as  determined  in  accordance 
with  Section  50505. 

(3)  Earnings  under  Title  1  of  the  Elementary  and  Secondary  Education 
Act. 

(4)  Payments  under  the  Job  Training  Partnership  Act  (JTPA).  Pay- 
ments which  are  identified  by  the  local  JTPA  office  as  an  incentive  pay- 
ment or  training  allowance  shall  be  considered  as  gross  unearned  income. 

(5)  Payments  under  the  Economic  Opportunity  Act. 

(6)  Training  incentive  payments  and  work  allowances  under  ongoing 
manpower  programs  other  than  WIN  or  JTPA. 

(7)  Income  received  for  having  provided  IHSS  services. 

(8)  Net  income  from  real  or  personal  property  as  determined  in  accor- 
dance with  Section  50508  which  is  the  result  of  continuous  and  apprecia- 
ble effort  on  the  part  of  the  applicant  or  beneficiary.  This  includes  income 
from: 

(A)  Room  and  board. 

(B)  The  rental  of  rooms  which  requires  daily  effort  on  the  part  of  the 
beneficiary. 

(C)  A  business  enterprise. 

(D)  The  sale  of  produce,  livestock,  poultry,  dairy  products  and  other 
similar  items. 

(9)  Earnings  from  public  service  employment. 

(10)  Actual  Earned  Income  Tax  Credit  (EITC)  payment  received  for 
taxable  year  1980  and  thereafter  whether  received  as  a  tax  refund  or  re- 
ceived as  an  advance  payment. 

(11)  Tips  actually  received  for  the  performance  of  work  activities,  not- 
withstanding the  amount  calculated  by  the  employer  for  tax  withholding 
purposes. 

(12)  For  purposes  of  applying  Sections  50543,  50553.1 ,  50553.3,  and 
50553.5  of  Title  22  of  the  California  Code  of  Regulations  to  AFDC-MN 
or  MI  persons.  Temporary  Workers  Compensation  payments  which  are 
(i)  employer  funded,  (ii)  made  to  an  individual  who  remains  employed 
during  recuperation  from  a  temporary  illness  or  injury  pending  his/her  re- 
turn to  the  job,  and  (iii)  are  specifically  characterized  under  State  law  as 
temporary  wage  replacements. 

(13)  For  purposes  of  applying  Sections  50543,  50553.1 ,  50553.3,  and 
50553.5  of  Title  22  of  the  California  Code  of  Regulations  to  AFDC-MN 
or  Ml  persons,  State  Disability  Insurance  payments. 

Note.  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  Sawyer  v.  Anderson,  Belshe,  et  al.,  U.S.  District  Court,  EDCA,  No.  CIV 
S-94-0228  GEB  JFM;  and  Tinoco  v.  Belshe,  U.S.  District  Court,  NDCA,  No.  C94 
0947  WHO.  Reference:  Sections  14005.4,  14005.7  and  14005.8,  Welfare  and  In- 
stitutions Code. 

History 

1 .  Amendment  filed  3-7-80;  effective  thirtieth  day  thereafter  (Register  80,  No.  9). 

2.  New  subsections  (a)(IO)  and  (b)  filed  4-15-85  as  an  emergency;  effective  upon 
filing  (Register  85,  No.  16).  A  Certificate  of  Compliance  must  be  transmitted 
to  OAL  within  120  days  or  emergency  language  will  be  repealed  on  8-13-85. 


3.  Certificate  of  Compliance  as  to  4-1 5-85  order  transmitted  to  OAL  8-13-85  and 
filed  9-18-85  (Register  85,  No.  38). 

4.  Amendment  filed  6-3-87;  operative  7-3-87  (Register  87,  No.  24). 

5.  New  subsections  (a)(l2)  and  (a)(I3)  and  amendment  of  NOTE  filed  3-1 1-97; 
operative  4-10-97  (Register  97,  No.l  I). 

§  50505.    Net  Profit  from  Self-Employment. 

(a)  The  net  profit  from  self-employment  shall  be  an  estimation  of  the 
annual  net  income  for  the  current  year  based  on  the  federal  tax  return  filed 
for  the  previous  year  as  limited  by  (c). 

(b)  If  there  is  no  tax  return  for  the  previous  year  or  there  is  evidence 
that  using  the  tax  return  would  give  an  inaccurate  estimation  of  income, 
the  county  department  shall  use  current  business  records.  In  this  circum- 
stance, net  profit  shall  be  determined  in  accordance  with  (d)  and  (e). 

(c)  The  following  expenses,  when  used  to  determine  annual  net  in- 
come on  the  federal  tax  return,  shall  not  be  deducted: 

(1)  Entertainment  costs. 

(2)  Depreciation. 

(3)  Purchase  of  capital  equipment  expenditures. 

(4)  Payments  on  the  principal  of  loans  for  capital  assets  or  durable 
goods. 

(d)  Net  profit  of  a  self-employed  person  shall  be  determined  by  sub- 
tracting from  the  gross  business  income,  expenses  which  are  directly  re- 
lated to  the  production  of  goods  or  services,  and  without  which  the  goods 
or  services  could  not  be  produced.  Such  expenses  include,  but  are  not 
hmited  to: 

(1 )  Transportation  costs  to  call  upon  customers  or  deliver  goods. 

(2)  Payments  of  the  interest  of  loans  for  capital  assets  or  durable  goods. 

(3)  Payments  for  rental  of  space  or  equipment. 

(4)  Wages  and  other  benefits  paid  to  employees. 

(5)  Material  and  supply  costs. 

(6)  Maintenance  and  repair  costs. 

(e)  Personal  expenses  such  as  income  tax  payments,  lunches  and  trans- 
portation to  and  from  work  are  not  classified  as  business  expenses  and 
shall  not  be  deducted. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Secnons  14005.4, 14005.7, 14005.9  and  14005.12,  Welfare  and 
Insfitutions  Code. 

History 

1.  Editorial  correction  adding  Note  filed  6-10-83  (Register  83,  No.  24). 

2.  Amendment  filed  4-17-89;  operafive  5-17-89  (Register  89,  No.  48). 

§  50507.    Gross  Unearned  Income. 

(a)  Gross  unearned  income  includes: 

(1)  Old  age,  survivors  and  disability  insurance  payments  from  the  So- 
cial Security  Administration  (OASDI). 

(2)  Annuities,  which  are  sums  paid  yearly  or  at  other  specific  intervals 
in  return  for  payment  of  a  fixed  sum  by  the  annuitant. 

(3)  Pensions. 

(4)  Retirement  payments. 

(5)  Disability  payments  except  for  the  State  Disability  Insurance  bene- 
fits considered  to  be  earned  income  under  Section  50503(a)(13)  of  this 
Title. 

(6)  Veterans  payments  which  include: 

(A)  Pensions  based  on  need. 

(B)  Compensation  payments. 

(C)  Educational  assistance. 

(7)  Workers'  Compensation  payments,  except  for  any  amount  deter- 
mined to  be  unavailable  in  accordance  with  Section  50515,  and  except 
for  Temporary  Workers  Compensation  payments  considered  to  be 
earned  income  under  Section  50503(a)(12)  of  this  Title. 

(8)  Railroad  Retirement  and  any  other  payments  made  by  the  Railroad 
Retirement  Board. 

(9)  Unemployment  Insurance  Benefits. 

(10)  Proceeds  from  a  life  insurance  policy  which  are  in  excess  of  the 
lesser  of: 

(A)  $1,500. 

(B)  The  amount  expended  on  the  insured  person's  last  illness  and  buri- 
al expenses. 


Page  362.3 


Register  98,  No.  5;  1  -30-98 


§  50508 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


(11)  Other  insurance  payments. 

(12)  Loans  which  do  not  require  repayment. 
(J  3)  Gifts. 

(14)  Non-exempt  child/spousal  support,  whether  provided  voluntari- 
ly or  by  court  order. 

(15)  Inheritances  which  are  in  the  form  of  cash,  securities  or  other  liq- 
uid assets. 

(16)  Contributions  from  any  source. 

(17)  Prizes  and  awards. 

(18)  Net  income  from  the  rental  of  real  or  personal  property  which  is 
not  considered  gross  earned  income  in  accordance  with  Section 
50503(a)(8). 

(19)  Dividends. 

(20)  Interest  payments  from  any  source,  including  trust,  trust  deeds 
and  contracts  of  sale. 

(21)  Royalties,  including  but  not  limited  to  payments  to  a  holder  of  a 
patent  or  copyright,  for  the  use  of  the  invention,  or  to  the  owner  of  a  mine, 
oil  well  or  similar  holdings,  for  the  extraction  of  the  product  or  other  use. 

(22)  Income  of  a  PA  or  Other  PA  recipient  which  is  not  used  to  deter- 
mine the  recipient's  eligibility. 

(23)  Incentive  payments  or  training  allowances  under  JTPA. 

(24)  Any  other  income  which  is  available  to  meet  current  needs  in  ac- 
cordance with  Section  50513. 

(25)  Any  of  the  items  specified  in  (10)  through  (24)  if  received  in  a 
lump  sum  payment. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  Sawyer  v.  Anderson,  Belshe,  et  a!..  U.S.  District  Court,  EDCA,  No.  CIV 
S-94-0228  GEB  JFM;  and  Tinoco  v.  Belshe,  U.S.  District  Court,  NDCA,  No.  C94 
0947  WHO.  Reference:  Sections  14005.4,  14005.7  and  14005.8,  Welfare  and  In- 
stitutions Code..  Reference:  Sections  14005.4, 14005.7, 14005.8  and  14006,  Wel- 
fare and  Institutions  Code. 

History 

1 .  Amendment  of  subsections  (a)(1),  (a)(l  2)  and  (a)(22)  filed  9-1 7-79  as  an  emer- 
gency; effective  upon  filing  (Register  9,  No.  38).  A  Certificate  of  Compliance 
must  be  filed  within  120  days  or  emergency  language  will  be  repealed  on 
1-15-80. 

2.  Certificate  of  Compliance  transmitted  to  OAL  1-8-80  and  filed  1-16-80  (Reg- 
ister 80,  No.  3). 

3.  Amendment  of  subsection  (a)(14)  and  new  subsection  (b)  filed  4—15-85  as  an 
emergency;  effective  upon  filing  (Register  85,  No.  16).  A  Certificate  of  Com- 
pliance must  be  transmitted  to  OAL  within  120  days  or  emergency  language 
will  be  repealed  on  8-13-85. 

4.  Certificate  of  Compliance  including  amendment  of  subsection  (a)  transmitted 
to  OAL  8-13-85  and  filed  9-18-85  (Register  85,  No.  38). 

5.  Amendment  filed  6-3-87;  operative  7-3-87  (Register  87,  No.  24). 

6.  Amendment  of  subsection  (a)(6)  filed  2-16-88  as  an  emergency;  operative 
2-1 6-88  (Register  88,  No.  10).  A  Certificate  of  Compliance  must  be  transmitted 
to  OAL  within  120  days  or  emergency  language  will  be  repealed  on  6-15-88. 

7.  Emergency  language  filed  2-16-88  repealed  by  operation  of  Government  Code 
Section  1 1 346. 1  (Register  88,  No.  27). 

8.  Amendment  of  subsecdon  (a)(6)  refiled  6-22-88  as  an  emergency;  operative 
6-22-88  (Register  88,  No.  27).  A  Certificate  of  Compliance  must  be  transmitted 
to  OAL  within  1 20  days  or  emergency  language  will  be  repealed  on  10-20-88. 

9.  Certificate  of  Compliance  transmitted  to  OAL  6-20-88  and  filed  7-15-88 
(Register88,  No.  31). 

10.  Amendment  of  subsections  (a)(5)  and  (a)(7)  and  amendment  of  NOTE  filed 
3-11-97;  operative  4-10-97  (Register  97,  No.ll). 

§  50508.    Net  Income  from  Property. 

(a)  Net  income  from  property  shall  be  considered  in  determining  share 
of  cost  and  shall  be  computed  as  follows: 

( 1 )  If  the  income  is  from  the  rental  of  real  property,  subtract  the  follow- 
ing expenses,  as  limited  by  (b),  from  the  gross  income: 

(A)  Taxes  and  assessments. 

(B)  Interest  on  encumbrance  payments.  The  principal  portion  of  the 
payments  shall  not  be  deducted. 

(C)  Insurance. 

(D)  Utilities. 

(E)  Upkeep  and  repairs.  The  amount  of  this  item  shall  be  the  greater 
of  the  following: 


1.  The  actual  amount  expended  for  upkeep  and  repairs  during  the 
month. 

2.  Fifteen  percent  of  the  gross  monthly  rental  plus  $4.17  per  month. 

(2)  In  determining  whether  utilization  requirements  are  met  in  accor- 
dance with  Section  5041 6  (a)  (1 )  only  the  amount  specified  in  (a)  ( 1 )  (E) 
1.  shall  be  deducted  rather  than  the  amount  specified  in  (a)  (1 )  (E)  2. 

(3)  If  the  income  is  from  the  rental  of  rooms,  or  the  provision  of  board 
and  room  or  board  and  care,  which  does  not  require  a  business  license, 
the  net  income  shall  be  10  percent  of  the  gross  amount  received. 

(4)  If  the  income  is  from  the  provision  of  board  and  room  or  board  and 
care  which  requires  a  business  license,  or  from  self-employment,  the  net 
income  is  the  net  profit  from  self-employment  as  determined  in  accor- 
dance with  Section  50505. 

(5)  If  the  income  is  from  a  deed  of  trust  or  a  mortgage,  the  net  income 
is  the  amount  specified  in  Section  50441  (c). 

(6)  If  the  income  is  from  property  in  which  the  person  holds  a  life  es- 
tate, the  net  income  is  the  ainount  actually  received. 

(7)  If  the  income  is  from  personal  property,  the  net  income  is  the 
amount  actually  received. 

(b)  If  the  income  is  from  the  rental  of  unit(s)  of  a  multiple  unit  dwelling 
or  other  dwellings  on  property  that  is  exempt  as  the  principal  residence 
and  the  applicant  or  beneficiary  is  living  in  a  portion  of  the  property,  the 
expenses  specified  in  (a)  which  are  common  to  the  property  as  a  whole 
shall  be  prorated  as  follows: 

(1)  Determine  the  number  of  rooms  in  the  building.  If  there  is  more 
than  one  building,  determine  the  number  of  rooms  in  all  of  the  buildings 
together.  For  the  purpose  of  this  section,  rooms  include  any  room  other 
than  the  following: 

(A)  Bathroom. 

(B)  Hallway. 

(C)  Closet. 

(D)  Unfinished  basement,  loft  or  attic. 

(2)  Determine  the  number  of  rooms  which  are  producing  the  rental  in- 
come. 

(3)  Based  upon  the  number  of  rooms,  determine  the  percentage  of  the 
property  which  is  producing  the  rental  income. 

(4)  Apply  the  percentage  determined  in  accordance  with  (3)  to  the  ex- 
penses specified  in  (a)  which  are  common  to  the  property  as  a  whole.  This 
is  the  amount  which  shall  be  subtracted  from  the  gross  income. 
NOTE:  Authority  cited:  Sections  10725,  14006.1  and  14124.5,  VMfare  and  Insti- 
tutions Code.  Reference:  Sections  14005.4, 14005.7  and  14006,  Welfare  and  Insti- 
tutions Code. 

History 

1 .  Amendment  of  subsection  (a)(5)  filed  1 2-15-77;  effective  thirtieth  day  thereaf- 
ter (Register  77,  No.  51 ). 

2.  Editorial  correction  adding  Note  filed  6-10-83  (Register  83,  No.  24). 

3.  Amendment  of  subsecfion  (a)(1)  and  new  subsection  (b)  filed  12-2-85  as  an 
emergency;  effective  upon  filing  (Register  85,  No.  50).  A  Certificate  of  Com- 
pliance must  be  transmitted  to  OAL  within  120  days  or  emergency  language 
will  be  repealed  on  4-1-86. 

4.  Certificate  of  Compliance  transmitted  to  OAL  3-31-86  and  filed  4-30-86 
(Register  86,  No.  18). 

§  50509.     Income  in  Kind. 

(a)  Income  in  kind  is  any  support  or  maintenance  received  in  kind  from 
a  person  other  than  a  responsible  relative  for: 

(1)  Housing. 

(2)  Utilities. 

(3)  Food. 

(4)  Clothing. 

(b)  Income  in  kind  shall  be  considered  as  income  only  if  the  entire  item 
of  need  is  provided. 

(c)  The  value  of  free  board  and  lodging  received  during  a  temporary 
absence  from  the  home  shall  be  considered  as  follows: 

(1)  If  the  absence  is  for  one  month  or  less,  the  income  in  kind  value 
shall  not  be  considered  income. 


[The  next  page  is  363.] 


Page  362.4 


Register  98,  No.  5;  1-30-98 


Title  22 


Health  Care  Services 


§  50512 


• 


(2)  If  the  absence  is  for  more  than  one  month,  the  income  in  kind  value 
shall  be  considered  income  to  the  extent  that  it  exceeds  the  actual  costs 
of  maintaining  the  home  to  which  the  beneficiary  will  return. 

(d)  Income  in  kind  which  is  received  as  earned  income  shall  be  subject 
to  earned  income  exemptions  and  deductions. 

(e)  Income  in  kind  which  is  received  as  unearned  income  shall  be  sub- 
ject to  unearned  income  exemptions  and  deductions. 

(0  Income  in  kind  from  a  parent  shall  not  be  considered  in  determining 
the  eligibility  of  a  child  when  any  of  the  following  conditions  exists: 

(1)  The  child's  application  is  being  processed  for  minor  consent  ser- 
vices in  accordance  with  Section  50147.1(a)(3)(D). 

(2)  The  child  is  an  unmarried  minor  parent  and  the  share  of  cost  is  be- 
ing determined  for  the  MFBU  that  includes  the  child's  children. 

(3)  The  child  is  an  unborn,  except  that  if  the  mother  is  receiving  in- 
come in  kind,  there  is  income  in  kind  to  the  unborn. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4  and  14005.7,  Welfaie  and  Institutions  Code. 

History 
1 .  New  subsection  (0  filed  1-8-81 :  effective  thirtieth  day  thereafter  (Register  81, 
No.  2). 


§  5051 1 .    Value  of  Income  In  Kind. 

(a)  Tlie  value  of  the  income  in  kind  for  the  items  specified  in  Section 
50509  (a)  shall  be  the  lesser  of  the  following: 

(1)  The  actual  cost  or  net  market  value  of  the  item,  or 

(2)  The  income  in  kind  amounts  effective  July  1, 1981  for  housing,  uti- 
lities (including  telephone),  food  and  clothing  specified  in  (d)  as  adjusted 
for  any  increases  or  decreases  in  the  cost  of  hving  specified  in  (b). 

(b)  Individual  income  in  kind  amounts  shall  be  adjusted  by  the  same 
percentage  increase  or  decrease  that  is  applied  to  the  AFDC  Maximum 
Aid  Payment  levels  pursuant  to  Section  11453  Welfare  and  Institutions 
Code.  Such  adjustments  shall  be  effective  at  the  same  time  as  adjust- 
ments to  the  AFDC  payment  levels  become  effective  as  specified  in  Sec- 
tion 11453,  Welfare  and  Institutions  Code. 

(c)  If  one  of  the  items  listed  in  50509(a)  is  shared  with  persons  who  are 
not  included  in  the  MFBU  and  who  are  not  responsible  for  members  of 
the  MFBU,  the  income  in  kind  value  to  the  members  of  the  MFBU  shall 
be  the  lesser  of: 

(1)  Their  share  of  the  net  market  value  or  actual  cost  of  the  item. 

(2)  The  value  determined  in  accordance  with  (a)  (2). 

(d)  The  income  in  kind  amounts  effective  July  1,  1981  are  as  follows: 

(1)  Housing. 

(A)  One  person  MFBU    $1 1 1  per  month. 

(B)  Two  person  MFBU   $150  per  month. 

(C)  Three  person  MFBU  $163  per  month. 

(1)  Housing. 

(A)  One  person  MFBU    $111  per  month. 

(B)  Two  person  MFBU  $150  per  month. 

(C)  Three  person  MFBU  $163  per  month. 

(D)  Four  person  or  larger  MFBU $173  per  month. 

(2)  Utilities,  including  telephone. 

(A)  One  person  MFBU    $25  per  month. 

(B)  Two  person  MFBU   $26  per  month. 

(C)  Three  person  MFBU  $28  per  month. 

(D)  Four  person  or  larger  MFBU $29  per  month. 

(3)  Food. 

(A)  One  person  MFBU    $62  per  month. 

(B)  Two  person  MFBU  $133  per  month. 

(C)  Three  person  MFBU  $169  per  month. 

(D)  Four  person  MFBU $209  per  month. 

(E)  Five  person  MFBU    $252  per  month. 

(F)  Six  person  MFBU    $293  per  month. 


(G)  Seven  person  MFBU $327  per  month. 

(H)  Eight  person  MFBU    $358  per  month. 

(I)  Nine  person  MFBU $391  per  month. 

(J)  Ten  person  or  larger  MFBU $424  per  month. 

(4)  Clothing. 

(A)  One  person  MFBU    $20  per  month. 

(B)  Two  person  MFBU   $37  per  month. 

(C)  Three  person  MFBU   $56  per  month. 

(D)  Four  person  MFBU $74  per  month. 

(E)  Five  person  MFBU    92  per  month. 

(F)  Six  person  MFBU    $1 10  per  month. 

(G)  Seven  person  MFBU $129  per  month. 

(H)  Eight  person  MFBU    $144  per  month. 

(I)  Nine  person  MFBU $165  per  month. 

(J)  Ten  person  or  larger  MFBU $1 81  per  month. 

NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  Section  32,  SB  633,  Statutes  of  1981,  Chapter  69.  Reference:  Sections 
14005.4  and  14005.7,  Welfare  and  Institutions  Code. 

History 

1.  Amendment  filed  7-1-77  as  an  emergency;  effective  upon  filing  (Register  77, 
No.  27). 

2.  Certificate  of  Compliance  filed  10-27-77  (Register  77,  No.  44). 

3.  Amendment  filed  9-25-79  as  an  emergency;  effective  upon  filing  (Register  79, 
No.  39).  A  Certificate  of  Compliance  must  be  filed  within  120  days  or  emergen- 
cy language  will  be  repealed  on  1-23-80. 

4.  Certificate  of  Compliance  filed  1-16-80  (Register  80,  No.  3). 

5.  Amendment  of  subsections  (a)  and  (c)  filed  9-30-80  as  an  emergency;  effective 
upon  filing  (Register  80,  No.  40).  A  Certificate  of  Compliance  must  be  trans- 
mitted to  OAL  within  120  days  or  emergency  language  will  be  repealed 
1-30-81. 

6.  Amendment  of  subsections  (a)  and  (c)  filed  12-3-80;  effective  thirtieth  day 
thereafter  (Register  80,  No.  49). 

7.  Certificate  of  Compliance  as  to  9-30-80  order  filed  1-27-81  (Register  81 ,  No. 

5). 

8.  Amendment  of  subsections  (a)  and  (c)  filed  lQ-2-81  as  an  emergency;  effective 
upon  filing  (Register  81,  No.  40). 

9 .  Certificate  of  Compli ance  as  to  1 0-2-8 1  order  transmitted  to  OAL  1  - 1 5-82  and 
filed  2-1-82  (Register  82,  No.  6). 

10.  Amendment  filed  1-13-86;  effective  thirtieth  day  thereafter  (Register  86,  No. 

3). 

§50512.    Ownership  of  Income. 

(a)  Except  as  specified  in  (b),  income  is  considered  to  belong  to  the 
person  who: 

(1)  Is  named  on  a  negotiable  instrument. 

(2)  Is  given  cash. 

(3)  Receives  the  income  in  kind. 

(b)  In  the  case  of  a  married  couple  it  shall  be  presumed  that  each  spouse 
has  a  one-half  community  property  ownership  interest  in  the  total 
monthly  gross  earned  and  unearned  income  of  both  spouses  providing  all 
of  the  following  conditions  exist: 

(1)  One  spouse  is  in  LTC  and  the  other  spouse  is  noninstitutionalized. 

(2)  There  is  no  break  in  marital  ties. 

(3)  The  LTC  spouse  receives  an  amount  of  income  which  is  greater 
than  the  amount  of  income  received  by  the  noninstitutionalized  spouse. 

(c)  The  community  property  ownership  presumption  in  (b)  shall  be  re- 
buttable by  either  spouse  who  provides  evidence  that  all  or  a  portion  of 
the  total  income  is  owned  separately  by  one  spouse. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  and  Section  5,  Chapter  122 1 ,  Statutes  of  1985.  Reference:  Sections  14005.4, 
14005.7  and  14005.16,  Wellareand  Institutions  Code;  and  Sections  687, 51 05  and 
51 10,  Civil  Code. 

History 

1.  Renumbering  and  amendment  of  former  Section  50513(d)  to  Section  50512 
filed  12-2-85  as  an  emergency;  effective  upon  filing  (Register  85,  No.  50).  A 
Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days  or  emer- 
gency language  will  be  repealed  on  4-1-86.  For  prior  history,  see  Register  77, 
No.  51. 

2.  Renumbering  and  amendment  of  former  Section  50513(d)  to  Section  50512  re- 
filed  3-28-86  as  an  emergency;  effective  upon  filing  (Register  86,  No.  13).  A 
Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120  days  or  emer- 
gency language  will  be  repealed  on  7-28-86. 


Page  363 


(4-1-90) 


§  50513 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


3.  Certificate  of  Compliance  includins  amendment  of  subsection  (b)  as  to  3-28-86 
ordered  filed  6-6-86  (Register  86rNo.  23). 

EXPLANATORY  NOTE: 

1 .  Approval  by  OAL  of  the  Certificate  of  Compliance  for  the  amendment  of  Sec- 
tion 50512,  filed  6-6-86,  was  made  in  the  absence  of  a  final  determination  by 
the  Secretary  of  the  United  States  Department  of  Health  and  Human  Services 
pursuant  to  Section  1 1 16  of  the  federal  Social  Security  Act  that  a  conflict  exists 
between  Section  50512  or  Chapter  1221  of  the  California  Statutes  of  1985  and 
any  federal  statute  or  regulation. 

§50513.     Availability  of  Income. 

(a)  Only  income  which  is  actually  available  to  meet  the  needs  of  a  per- 
son or  family  shall  be  considered  in  determining  that  person's  or  family's 
share  of  cost. 

(b)  Income  shall  be  considered  available  in  the  month  it  is  received  un- 
less it  is: 

(1)  To  be  apportioned  over  time  in  accordance  with  Section  50517. 

(2)  Unavailable  in  accordance  with  Section  50515. 

(c)  Income  is  considered  to  be  received  on  the  day  it  becomes  available 
for  use  by  the  person. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  and  Section  5,  Chapter  1221,  Statutes  of  1985.  Reference:  Sections  14005.4, 
14005.7  and  14005.16,  Welfare  and  Institutions  Code:  and  Sections  687, 5105  and 
5110,  Civil  Code. 

History 

1.  Amendment  of  subsection  (d)  filed  12-1 5-77;  effective  thirtieth  day  thereafter 
(Register77,  No.  51). 

2.  Renumbering  and  amendment  of  Section  50513(d)  to  Section  50512  filed 
12-2-85  as  an  emergency;  effective  upon  filing  (Register  85,  No.  50).  A  Certifi- 
cate of  Compliance  must  be  transmitted  to  OAL  within  1 20  days  or  emergency 
language  will  be  repealed  on  4-1-86. 

3.  Renumbering  and  amendment  of  Secfion  50513(d)  to  Section  50512  refiled 
3-28-86  as  an  emergency ;  effective  upon  filing  (Register  86,  No.  1 3).  A  Certifi- 
cate of  Compliance  must  be  transmitted  to  OAL  within  1 20  days  or  emergency 
language  will  be  repealed  on  7-28-86. 

§  50515.     Unavailable  Income. 

(a)  Income  which  is  not  available  to  meet  current  needs  of  a  person  or 
family  shall  not  be  considered  in  determining  that  person's  or  family's 
share  of  cost.  Unavailable  income  includes,  but  is  not  limited  to,  the  fol- 
lowing: 

(1 )  That  portion  of  Worker' s  Compensation  and  other  public  or  private 
insurance  settlements  which  is  either  of  the  following: 

(A)  Designated  for  medical,  legal  or  other  such  expenses. 

(B)  Not  controlled  by  the  applicant  or  beneficiary  or  person  acting  on 
his  behalf 

(2)  That  portion  of  a  contribution  that  is  both  of  the  following: 

(A)  From  a  person  living  in  the  household  who  has  no  legal  responsi- 
bility to  support,  such  as  an  unrelated  adult  or  an  adult  child. 

(B)  Used  to  meet  the  actual  costs  of  the  contributor' s  share  of  the  hous- 
ing, utilities,  food  and  other  household  costs.  If  actual  costs  are  unavail- 
able, the  amounts  specified  in  Section  50511  shall  be  used.  This  shall  be 
the  difference  between  the  income-in-kind  values  for  the  family  size 
with  the  person  included  and  excluded. 

(3)  That  portion  of  the  monthly  income  of  a  medically  needy  person 
residing  in  a  licensed  board  and  care  facility  which  is  both  of  the  follow- 
ing: 

(A)  Paid  to  the  facility  for  residential  care  and  support, 

(B)  In  excess  of  the  appropriate  maintenance  need  level  as  determined 
in  accordance  with  Section  50603. 

(4)  An  advance  or  a  reimbursement  from  an  employer  to  cover  ex- 
penses necessary  for  job  performance  is  unavailable  to  the  extent  that  the 
advance  or  reimbursement  does  not  exceed  the  actual  out-of-pocket 
costs  of  the  employee. 

(b)  When  a  person  is  in  LTC  and  is  in  his/her  own  MFBU  in  accor- 
dance with  Section  50377,  his/her  spouse's  share  of  the  community  prop- 
erty owned  income  shall  be  considered  unavailable  to  the  LTC  person. 
NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4,  14005.7  and  14005.16,  Welfare  and  Institu- 
tions Code. 


History 

1.  New  subsection  (a)(3)  filed  11-17-83  as  an  emergency;  effective  upon  filing 
(Register  83,  No.  49).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL 
within  120  days  or  emergency  language  will  be  repealed  on  3-1 7-84. 

2.  Certificate  of  Compliance  as  to  1 1-17-83  order  transmitted  to  OAL  3-16-84 
and  filed  4-17-84  (Register  84,  No.  16). 

3.  New  subsection  (b)  filed  1 2-2-85  as  an  emergency;  effective  upon  filing  (Reg- 
ister 85,  No.  50).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  with- 
in 120  days  or  emergency  language  will  be  repealed  on  4-1-86. 

4.  New  subsection  (b)  refiled  3-28-86  as  an  emergency;  effective  upon  filing 
(Register  86.  No.  13).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL 
within  120  days  or  emergency  language  will  be  repealed  on  7-28-86. 

5.  Certificate  of  Compliance  as  to  3-28-86  order  filed  6-6-86  (Register  86,  No. 
23). 

EXPLANATORY  NOTE: 

1 .  Approval  by  OAL  of  the  Certificate  of  Compliance  for  the  amendment  of  Sec- 
tion 50515(b),  filed  6-6-86,  was  made  in  the  absence  of  a  final  determination 
by  the  Secretary  of  the  United  States  Department  of  Health  and  Human  Services 
pursuant  to  Section  1 1 16  of  the  federal  Social  Security  Act  that  a  conflict  exists 
between  Section  50515(b)  or  Chapter  1221  of  the  California  Statutes  of  1985 
and  any  federal  statute  or  regulation. 

6.  New  subsecfion  (a)(4)  filed  7-9-87;  operaUve  8-8-87  (Register  87,  No.  30). 

§  5051 7.    Apportionment  of  Income  over  Time. 

(a)  Income  shall  be  considered  available  in  the  month  received,  unless 
it  is  apportioned  over  time  in  accordance  with  the  following: 

(1)  Income  earned  and  received  in  more  than  eight  but  less  than  twelve 
months  under  an  annual  contract  of  employment  shall  be  apportioned 
equally  over  the  period  of  the  contract  beginning  with  the  first  month  of 
the  contract. 

(2)  Income  received  more  frequently  than  monthly  or  semi-monthly 
shall  be  converted  to  monthly  income  in  accordance  with  (3)  if  both  of 
the  following  conditions  are  met: 

(A)  The  beneficiary  wishes  to  receive  Medi-Cal  for  more  than  two 
months. 

(B)  The  beneficiary  is  to  receive  the  income  for  a  full  month. 

(3)  Income  shall  be  converted  to  monthly  income  by  the  following 
methods: 

(A)  Multiply  weekly  income  by  4.33  or  4  1/3. 

(B)  Multiply  income  received  every  two  weeks  by  2. 167  or  2  1/6. 

(4)  Income  received  less  frequently  than  monthly  shall  be  converted 
to  monthly  income  by  the  following  methods. 

(A)  Divide  quarterly  income  by  three. 

(B)  Divide  income  received  every  two  months  by  two. 

(5)  Income  from  self-employment,  as  determined  in  accordance  with 
Section  50505,  shall  be  determined  on  an  annual  basis  and  apportioned 
monthly. 

(6)  Loans  which  do  not  require  repayment  and  are  not  exempt  in  accor- 
dance with  Section  50533,  and  which  specify  that  they  are  to  cover  a  cer- 
tain period  of  time  shall  be  apportioned  over  that  period  of  time. 

(7)  Interest  income  from  a  deed  of  trust  or  contract  of  sale  shall  be  de- 
termined on  an  annual  basis  and  apportioned  monthly. 

(8)  Interest  income  which  is  received  less  frequently  than  monthly  and 
is  not  exempt  as  specified  in  Section  50542  shall  be  apportioned  as  fol- 
lows: 

(A)  Determine  the  number  of  months  of  the  period  during  which  the 
interest  accrued. 

(B)  Divide  the  interest  income  by  the  number  of  months  in  the  interest 
period. 

(C)  Consider  the  amount  determined  in  (B)  as  income  in  each  of  the 
months  of  the  next  interest  period. 

NOTE:  Authority  cited:  Sections  10725, 14005.9(c)  and  14124.5,  Welfare  and  In- 
stitufions  Code;  Section  133.5,  AB  251,  Chapter  102,  Statutes  of  1981 .  Reference: 
Sections  14005.4,  14005.7,  14005.9,  and  14006,  Welfare  and  Institutions  Code. 

History 

L  Amendment  of  subsection  (a)  and  repealer  of  subsection  (b),  filed  12-15-77; 
effective  thirtieth  day  thereafter  (Register  77,  No.  51). 

2.  Amendment  of  subsection  (a)(6)  filed  9-1 7-79  as  an  emergency;  effective  upon 
filing  (Register  79,  No.  38).  A  Certificate  of  Compliance  must  be  filed  within 
120  days  or  emergency  language  will  be  repealed  on  1-15-80. 

3.  Certificate  of  Compliance  transmitted  to  OAH  1-8-80  and  filed  1-16-80  (Reg- 
ister 80,  No.  3). 


Page  364 


(4-1-90) 


Title  22 


Health  Care  Services 


§  50528 


• 


4.  Amendment  filed  11-30-81  as  an  emergency;  effective  upon  filing  (Regisier 
81 ,  No.  49).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  1 20 
days  or  emergency  language  will  be  repealed  on  3-30-82. 

5.  Certificate  of  Compliance  filed  3-30-82  (Register  82,  No.  14). 

6.  Amendment  of  subsection  (a)  filed  10-1-82  as  an  emergency;  effective  upon 
filing  (Register  82,  No.  40).  A  Certificate  of  Compliance  must  be  transmitted 
to  OAL  within  120  days  or  emergency  language  will  be  repealed  on  1-29-83. 

7.  Certificate  of  Compliance  transmitted  to  OAL  12-30-82  and  filed  2-2-83 
(Register  83,  No.  6). 

§  5051 7.1 .    Apportionment  of  Income  Exemptions  and 
Deductions. 

(a)  Income  exemptions  and  deductions  shall  be  apportioned  over  time 
using  the  procedures  for  apportioning  income  over  time. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5.  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4  and  14005.7,  Welfare  and  Institutions  Code. 

History 

1 .  New  section  filed  1 2-1 5-77;  effective  thirtieth  day  thereafter  (Register  77,  No. 
51). 

2.  Editorial  con-ection  adding  NOTE  filed  6-1 1-83  (Register  83,  No.  24). 

§  50518.    Fluctuating  Income. 

(a)  Fluctuating  income  shall  be  determined  by  estimating  the  amount 
to  be  received  in  the  month  unless  the  conditions  of  (b)  are  met.  This  esti- 
mate shall  be  made  considering  all  of  the  following: 

(1)  The  income  pattern  over  the  last  year. 

(2)  The  actual  income  received  in  the  last  month. 

(3)  The  beneficiary's  statement  of  anticipated  income. 

(b)  Actual  income  shall  be  used  if  it  is  known  at  the  time  the  share  of 
cost  determination  is  being  made.  In  no  instance  shall  the  share  of  cost 
determination  be  delayed  solely  to  determine  the  actual  income. 

(c)  The  provisions  of  this  section  shall  not  apply  to  income  from  self- 
employment  which  shall  be  determined  in  accordance  with  Section 
50505  and  apportioned  in  accordance  with  Section  50517(a)(5). 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4,  14005.7  and  14005.12,  Welfai'e  and  Institu- 
tions Code. 

History 

1.  Editorial  correcfion  adding  NOTE  filed  6-10-83  (Register  83,  No.  24). 

2.  New  subsection  (c)  filed  7-9-87;  operative  8-8-87  (Register  87,  No.  30). 

§  50519.    Income  Exemptions  and  Deductions — General. 

(a)  Certain  items  of  earned  and  unearned  income  shall  be  exempt  from 
consideration  in  determining  a  beneficiary's  share  of  cost.  Income  which 
remains  after  the  apphcation  of  the  exemptions  specified  in  Sections 
50523  through  50544  shall  be  nonexempt  income. 

(b)  Certain  amounts  of  income  shall  be  deducted  from  nonexempt  in- 
come to  determine  the  net  income  to  be  used  in  determining  the  share  of 
cost.  Income  which  remains  after  the  application  of  the  deductions  speci- 
fied in  Sections  50547  through  50555.2  shall  be  net  nonexempt  income. 

(c)  Exemptions  and  deductions  do  not  apply  uniformly  to  all  MN  and 
MI  categories  nor  to  both  earned  and  unearned  income.  Restrictions  are 
stated  where  applicable. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  and  Section  57(c),  Chapter  328,  Statutes  of  1982.  Reference:  Secfions 
14005.4  and  14005.7,  Welfare  and  Institutions  Code. 

History 

1.  Amendment  of  subsection  (b)  filed  8-18-82  as  an  emergency;  effective  upon 
filing  (Register  82,  No.  34).  A  Certificate  of  Compliance  must  be  transmitted 
to  OAL  within  120daysoremergency  language  will  be  repealed  on  12-16-82. 

2.  Certificate  of  Compliance  transmitted  to  OAL  12-16-82  and  filed  1-21-83 
(Register  83,  No.  4). 

3.  Amendment  of  NOTE  filed  4-12-83  (Register  83,  No.  16). 

§  50521 .    Payments  Exempt  from  Consideration  as  Income. 

Income  specified  in  Sections  50523  through  50544  shall  be  exempt. 
These  exemptions  shall  apply  to  all  MN  and  MI  persons,  unless  other- 
wise specified. 

§  50523.     Property  Tax  Refunds. 

Refunds  or  rebates  of  taxes  on  real  property  shall  be  exempt. 


NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institufions 
Code.  Reference:  Sections  14005.4  and  14005.7,  Welfare  and  Institutions  Code. 

History 
1 .  Editorial  conecfion  adding  NOTE  filed  6-10-83  (Register  83,  No.  24). 

§  50523.5.    California  Franchise  Tax  Board  Payments. 

The  payments  which  are  exempt  property  pursuant  to  Section  50454.5 
shall  also  be  exempt  income  in  the  month  of  receipt. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Section  1 1008.4,  Welfare  and  Institutions  Code. 

History 

1.  New  section  filed  4-17-89;  operative  5-17-89  (Register  89,  No.  48). 

§  50524.    Child/Spousal  Support  Received  by  AFDC-MN 
and  Ml  Family  Members. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code;  and  Section  14,  Chapter  1447,  Statutes  of  1984.  Reference:  Sections 
14005.4,  14005.7  and  14005.8,  Welfare  and  Insfitufions  Code. 

History 

1 .  New  section  filed  4-15-85  as  an  emergency;  effective  upon  filing  (Register  85, 
No.  16).  A  Certificate  of  Compliance  must  be  transmitted  to  OAL  within  120 
days  or  emergency  language  will  be  repealed  on  8-13-85. 

2.  Certificate  of  Compliance  transmitted  to  OAL  8-13-85  and  filed  9-18-85 
(Register  85,  No.  38). 

3.  Renumbering  and  amendment  of  Section  50524  to  Secfion  50554.5  filed 
7-9-87;  operative  8-8-87  (Register  87,  No.  30). 

§  50525.    Public  Assistance  and  General  Relief  Grants. 

(a)  Public  assistance  cash  grants  shall  be  exempt. 

(b)  In  addition  to  public  assistance  cash  grants,  the  following  cash  pay- 
ments from  county  agencies  are  exempt: 

(1)  Special  circumstances  payments  provided  to  SSI/SSP  recipients 
pursuant  to  EAS  regulations. 

(2)  Emergency  loans  provided  to  SSI/SSP  recipients  pursuant  to  EAS 
regulations. 

(3)  General  Relief  or  General  Assistance  payments. 

(4)  Cash  value  of  food  stamps. 

(5)  Immediate  need  payments  provided  to  AFDC  recipients  pursuant 
to  EAS  40-129. 

NOTE;  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institufions 
Code.  Reference:  Sections  14005.4  and  14005.7,  Welfare  and  Insfitutions  Code. 

History 
1 .  New  subsecfions  (b)(4)  and  (b)(5)  filed  8-8-80;  effective  thirtieth  day  thereafter 
(Register  80,  No.  32). 

§  50526.    Work  Incentive  Program  (WIN). 

Earnings  from  public  service  employment  under  the  WIN  program  are 
exempt. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Secfions  14005.4  and  14005.7,  Welfare  and  Insfitufions  Code. 

History 
1 .  New  section  filed  3-7-80;  effective  thirtieth  day  thereafter  (Register  80,  No.  9). 

§  50527.    Social  Services. 

(a)  Payments  received  for  social  services  provided  in  accordance  with 
Title  XX  of  the  Social  Security  Act  shall  be  exempt,  whether  provided 
in  kind  or  as  a  direct  payment  to  the  individual  for  purchase  of  designated 
services.  Such  services  include,  but  are  not  limited  to: 

(1)  In-Home  Supportive  Services. 

(2)  Child  care. 

(3)  Training  and  rehabilitation  services,  including  payment  for  train- 
ing expenses. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Insfitutions 
Code.  Reference:  Secfions  14005.4,  and  14005.7,  Welfare  and  Insfitufions  Code. 

History 

1 .  Amendment  of  subsection  (a)(1)  filed  8-7-78;  effective  thirtieth  day  thereafter 
(Register  78,  No.  32). 

2.  Editorial  cortecfion  adding  NOTE  filed  6-10-83  (Register  83,  No.  24). 

§  50528.  Assistance  Based  on  Need. 

(a)  Assistance  based  on  need  which  is  furnished  by  the  State  or  any  po- 
htical  jurisdiction  thereof,  as  specified  in  (b),  shall  be  exempt  if  the  pay- 
ment is  all  of  the  following: 


Page  365 


Register  93,  No.  41;  10-8-93 


§  50529 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


(1)  Made  regularly  on  a  periodic  basis  at  least  once  a  quarter  or  made 
to  a  specific  group  or  class  of  individuals  in  similar  circumstances  or  situ- 
ations. 

(2)  Made  in  cash,  which  may  be  currency  or  any  negotiable  instru- 
ment. 

(3)  Issued  in  an  amount  based  on  the  need  of  the  individual. 

(b)  Assistance  based  on  need  includes  payments  from  the  following 
and  similar  sources: 

(1)  Short-Doyle. 

(2)  Regional  centers  for  the  Developmentally  Disabled. 

(3)  Probation  departments. 

(c)  Payments  made  pursuant  to  public  law,  when  the  law  specifically 
exempts  such  payment  from  eligibility  and  share  of  cost  determinations, 
shall  be  considered  assistance  based  on  need. 

NOTE;  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4  and  14005.7,  Welfare  and  Institutions  Code. 

History 
1 .  Amendment  filed  3-7-80;  effective  thirtieth  day  thereafter  (Register  80,  No.  9). 

§  50529.    Federal  Housing  Assistance. 

(a)  Federal  housing  assistance  in  the  form  of  rent  subsidies,  loans  or 
partial  house  payments  under  the  U.  S.  Housing  Act  of  1937,  the  National 
Housing  Act,  Title  V  of  the  Housing  Act  of  1949  or  the  Housing  and  Ur- 
ban Development  Act  of  1965  shall  be  exempt. 

History 

1 .  Amendment  filed  12-15-77;  effective  thirtieth  day  thereafter  (Register  77,  No. 
51). 

§  50530.    Training  Expenses. 

The  allowance  for  training  expenses  paid  by  the  Department  of  Reha- 
bilitation to  persons  participating  in  that  Department's  training  programs 
shall  be  exempt. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4  and  14005.7,  Welfare  and  Institutions  Code. 

History 

1 .  New  section  filed  as  an  emergency  6-1 7-80  (Register  80,  No.  25).  A  Certificate 
of  Compliance  must  be  transmitted  to  OAH  within  120  days  or  emergency  lan- 
guage will  be  repealed  on  10-16-80. 

2.  Certificate  of  Compliance  filed  9-26-80  (Register  80,  No.  39). 

§  50531 .    Foster  Care  Payments. 

(a)  Payments  from  any  source,  received  by  a  foster  parent  for  the  care 
of  a  foster  child,  shall  be  exempt  except  for: 

(1)  The  portion  of  the  payment  designated  by  the  county  department 
for  care  and  supervision,  if  such  a  designation  is  made. 

(2)  Payments  made  to  a  foster  parent  when  a  foster  child  is  temporarily 
absent  from  the  foster  home  for  a  month  or  more. 

(3)  Payments  made  to  ensure  availability  of  a  room  or  rooms  for  foster 
children. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4,  and  14005.7,  Welfare  and  Institutions  Code. 

History 
1 .  Editorial  correcnon  adding  NOTE  filed  6-10-83  (Register  83,  No.  24). 

§  50533.    Exempt  Loans,  Grants,  Scholarships  and 
Fellowships. 

(a)  The  following  loans,  grants,  scholarships  and  fellowships  are  ex- 
empt: 

(1)  Loans  made  under  Title  III  of  the  Federal  Economic  Opportunity 
Act,  Special  Program  to  Combat  Poverty  in  Rural  Areas. 

(2)  Loans  or  grants  to  an  undergraduate  student  for  educational  pur- 
poses made  or  insured  by  the  Federal  Commissioner  of  Education.  These 
include,  but  are  not  limited  to: 

(A)  Supplemental  Education  Opportunity  grants. 

(B)  National  Direct  Student  loans. 

(C)  College  Work  Study. 

(D)  Basic  Educational  Opportunity  grants. 

(E)  Federal  insured  student  loans. 


(3)  Educational  loans  or  grants  to  undergraduate  students  when  it  is 
verified  that  they  are  awarded  on  the  basis  of  the  student's  need.  These 
include,  but  are  not  limited  to: 

(A)  Extended  Opportunity  Program  loans  and  grants. 

(B)  Bureau  of  Indian  Affairs  loans  and  grants. 

(C)  California  State  scholarships  (Cal  Grant  A). 

(D)  College  Opportunity  grants  (Cal  Grant  B). 

(E)  Occupational,  Educational-Training  grants  (Cal  Grant  C). 

(4)  Funds  for  readers,  or  educational  scholarships,  which  are  all  of  the 
following: 

(A)  Provided  to  an  aged,  blind  or  disabled  person  enrolled  in  a  Califor- 
nia public  school  or  institution  of  higher  learning. 

(B)  Awarded  by  an  educational  institution. 

(C)  Not  available  to  tneet  basic  needs. 

(5)  Other  loans,  grants,  scholarships  or  fellowships,  or  portions  there- 
of, to  undergraduate  or  graduate  students  if  the  following  conditions  are 
met: 

(A)  The  loan,  grant,  scholarship  or  fellowship  document  specifically 
limits  the  use  of  the  funds  for  purposes  other  than  current  living  costs. 

(B)  The  loan,  grant,  scholarship  or  fellowship  would  not  be  available 
if  used  for  any  purpose  other  than  the  one  specified. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4,  14005.7,  11008.7,  11008.9,  11008.10  and 
12152,  Welfare  and  Institutions  Code. 

History 

1 .  Amendment  of  subsecfion  (a)  filed  12-15-77;  effective  thirtieth  day  thereafter 
(Register77,  No.  51). 

2.  Amendment  filed  3-7-80;  effective  thirtieth  day  thereafter  (Register  80,  No.  9). 

§  50534.    Payments  to  Victims  of  Crimes — Treatment  as 
Income. 

Payments  made  under  the  California  Victims  of  Crimes  program  shall 
be  exempt  as  income  in  the  month  of  receipt  and  thereafter  as  property 
in  accordance  with  Section  50448,  and  shall  not  be  considered  to  be  un- 
conditionally available  income  pursuant  to  Section  50186. 
NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Institufions 
Code;  and  Secfions  1382a(b),  1383(a)(9)  and  1396a(r),  Title  42,  United  States 
Code.  Reference:  Sections  14005.4  and  14005.7,  Welfare  and  Insfitufions  Code 
and  Secfion  13959  et  seq..  Government  Code. 

History 

1 .  New  secfion  filed  as  an  emergency  6-17-80  (Register  80,  No.  25).  A  Certificate 
of  Compliance  must  be  transmitted  to  OAL  within  1 20  days  or  emergency  lan- 
guage will  be  repealed  on  10-16-80. 

2.  Certificate  of  Compliance  filed  9-26-80  (Register  80,  No.  39). 

3.  Amendment  of  secfion  heading,  text  and  Note  filed  10-4-93;  operafive 
1 1-3-93  (Register  93,  No.  41). 

§  50535.     Relocation  Assistance  Benefits. 

Relocation  assistance  benefits  shall  be  exempt  if  paid  by  a  public 
agency  to  a  person  who  has  been  relocated  as  a  result  of  a  program  of  area 
redevelopment,  urban  renewal,  freeway  construction,  or  any  other  public 
development  involving  demolition  or  condemnation  of  existing  housing. 
NOTE;  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  InsUtutions 
Code.  Reference:  Secfions  14005.4  and  14005.7,  Welfare  and  Institutions  Code. 

History 

1 .  Editorial  correction  adding  NOTE  filed  6-10-83  (Register  83,  No.  24). 

§  50535.5.    Disaster  and  Emergency  Assistance  Payments. 

Disaster  and  emergency  assistance  payments,  whether  in  cash  or  in- 
kind,  regardless  of  the  date  of  receipt,  and  any  interest  earned  from  such 
payments,  shall  be  exempt  and  shall  not  be  included  in  the  share  of  cost 
computation.  This  exemption  applies  only  to  such  payments  received 
from  federal,  state,  and  local  government  agencies,  or  disaster  assistance 
organizations. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Insfitufions 
Code.  Reference:  Sections  14005.4  and  14005.7,  Welfare  and  Insfitufions  Code; 
and  42  U.S.C.  Secfions  1382a(b)(l  I)  and  (12),  1382b(a)(6),  I396a(aK10),  5121 
et  seq.  and  5155(d). 

History 
1.  New  secfion  filed  10-5-93;  operafive  1 1-^1-93  (Register  93,  No.  41). 


Page  366 


Register  9.1,  No.  41;  10-8-93 


Title  22 


Health  Care  Services 


§  50543 


§  50536.    Payments  to  Victims  of  the  National  Socialist 
Persecution. 

(a)  Payments  received  from  the  Federal  Republic  of  Germany  (Ger- 
man Reparations  Payments)  pursuant  to  the  federal  law  on  the  Compen- 
sation of  Victims  of  the  National  Socialist  Persecution  (Federal  Compen- 
sation Law)  as  enacted  on  June  29, 1 956  shall  be  exempt  as  income  in  the 
month  received. 

(b)  Interest  earned  on  German  Reparations  Payments  shall  not  be  ex- 
empt and  shall  be  considered  countable  unearned  income  in  the  month 
received. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.5,  and  14006,  Welfare  and  Institutions  Code, 
and  Program  Operations  Manual  System  SI  01120.405. 

HtSTORY 

1.  New  section  filed  1 2-1 0-85;  effective  thirtieth  day  thereafter  (Register  85,  No. 
50). 

2.  Amendment  filed  9-4-91;  operative  10-4-91  (Register  92,  No.  2). 


§  50537.    Federal  Payments  to  Indians  and  Alaskan 
Natives — Income. 

(a)  Payments  made  to  Indians  under  Public  Law  90-507  shall  be  con- 
sidered personal  property  rather  than  income  to  the  extent  specified  in 
Section  50445. 

(b)  Per  capita  payments  made  to  Indians  under  Section  6  of  Public  Law 
87-775  and  Public  Law  92-254  shall  be  exempt. 

(c)  Per  capita  payments  distributed  pursuant  to  any  judgment  of  the  In- 
dian Claims  Commission  or  the  Court  of  Claims  in  favor  of  any  Indian 
Tribe  are  exempt. 

(d)  Payments  made  to  Alaskan  Natives  under  the  Alaskan  Native 
Claims  Settlement  Act  are  exempt.  Income  obtained  from  stock  invest- 
ments under  the  Act  is  not  exempt. 

(e)  Receipts  derived  from  lands  held  in  trust  and  distributed  by  the  fed- 
eral government  to  members  of  the  following  Indian  tribes  are  exempt: 

(1)  Bad  River  Bank  of  the  Lake  Superior  Tribe  of  Chippewa  Indians 
of  Wisconsin. 

(2)  Blackfeet  Tribe,  Blackfeet,  Montana. 

(3)  Cherokee  Nation  of  Oklahoma,  Oklahoma. 

(4)  Cheyenne  River  Sioux  Tribe,  Cheyenne  River,  South  Dakota. 

(5)  Crow  Creek  Sioux  Tribe,  Crow  Creek,  South  Dakota. 

(6)  Lower  Brule  Sioux  Tribe,  Lower  Brule,  South  Dakota. 

(7)  Devil's  Lake  Sioux  Tribe,  Fort  Totten,  North  Dakota. 

(8)  Fort  Belknap  Indian  Community,  Fort  Belknap,  Montana. 

(9)  Assinboine  and  Sioux  Tribes,  Fort  Peck,  Montana. 

(10)  Lac  Courte  Oreilles  Band  of  Lake  Superior  Chippewa  Indians, 
Lac  Courte  and  Oreilles,  Wisconsin. 

(11)  Keweenaw  Bay  Indian  Community,  L'Anse,  Michigan. 

(12)  Minnesota  Chippewa  Tribe,  White  Earth,  Minnesota. 

(13)  Navajo  Tribe,  Navajo,  New  Mexico. 

(14)  Oglala  Sioux  Tribe,  Pine  Ridge,  South  Dakota. 

(15)  Rosebud  Sioux  Tribe,  Rosebud,  South  Dakota. 

(16)  Shoshone-Bannock  Tribe,  Fort  Hall,  Idaho. 

(17)  Standing  Rock  Sioux  Tribe,  Standing  Rock,  North  and  South 
Dakota. 

(18)  Seminole  Indians,  Florida. 

(19)  Pueblos  of  Zia  and  Jemez,  New  Mexico. 

(20)  Stockbridge  Munsee  Indian  Community,  Wisconsin. 

(21)  Bums  Indian  Colony,  Oregon. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4  and  14005.7,  Welfare  and  Institutions  Code. 

History 

1 .  New  subsection  (e)  filed  as  an  emergency  6-17-80  (Register  80,  No.  25).  A  Cer- 
tificate of  Compliance  must  be  transmitted  to  OAH  within  120  days  or  emergen- 
cy language  will  be  repealed  on  10-16-80. 

2.  Certificate  of  Compliance  filed  9-26-80  (Register  80,  No.  39). 

3.  Change  without  regulatory  of  subsection  (a)  (Register  87,  No.  11). 


§  50538.    VISTA  Payments. 

Payments  made  under  the  Domestic  Volunteer  Services  Act  of  1973 
to  VISTA  volunteers  are  exempt. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4  and  14005.7,  Welfare  and  Institutions  Code. 

History 
1.  Editorial  correction  adding  NOTE  filed  6-10-83  (Register  83,  No.  24). 

§  50539.    Job  Training  Partnership  Act  (JTPA)  Payments. 

(a)  All  earnings  of  a  child  which  are  derived  from  participation  in 
JTPA  prograiTis  shall  be  exempt  for  up  to  six  months  per  calendar  year. 
Other  JTPA  payments  made  to  a  child  shall  be  exeinpt  at  all  times. 

(b)  Payments,  other  than  earnings,  to  an  adult  which  are  derived  from 
participation  in  JTPA  programs  shall  be  exempt  to  the  extent  that  the  pay- 
ment reimbursements  do  not  exceed  the  adult's  actual  training  expenses. 
NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Sections  14005.4  and  14005.7,  Welfare  and  Institutions  Code. 

History 

1 .  Amendment  filed  3-7-80;  effective  thirtieth  day  thereafter  (Register  80,  No.  9). 

2.  Repealer  and  new  section  filed  6-3-87;  operative  7-3-87  (Register  87,  No.  24). 

§  50540.    Executive  Volunteer  Programs. 

Payments  for  supportive  services  or  reimbursement  of  out-of-pocket 
expenses  made  to  persons  serving  in  the  Service  Corps  of  Retired  Execu- 
tives (SCORE)  and  the  Active  Corps  of  Executives  (ACE)  pursuant  to 
Section  418  of  Public  Law  93-113  are  exempt. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Insfitutions 
Code.  Reference:  Sections  14005.4  and  14005.7,  Welfare  and  Institutions  Code. 

History 
1.  Editorial  correction  adding  NOTE  filed  6-10-83  (Register  83,  No.  24). 

§  50541 .    Senior  Citizen  Volunteer  Programs. 

Compensation  received  by  beneficiaries  who  are  60  years  of  age  or 
older,  for  volunteer  services  performed  under  the  Retired  Senior  Volun- 
teer program,  the  Foster  Grandparents  program  or  the  Older  Americans 
Community  Service  program  of  the  National  Older  Americans  Act,  shall 
be  exempt. 

NOTE:  Authority  cited:  Sections  10725  and  14124.5,  Welfare  and  Institutions 
Code.  Reference:  Secfions  14005.4  and  14005.7,  Welfare  and  Institutions  Code. 

History 
I.  Editorial  correcfion  adding  NOTE  filed  6-10-83  (Register  83,  No.  24). 

§  50542.    Irregular  or  Infrequent  Income. 

(a)  The  first  $60  of  casual  or  inconsequent al  unearned  income  per  cal- 
endar quarter  shall  be  exempt  if  either  of  the  following  conditions  are 
met. 

(1)  The  income  is  received  not  more  than  twice  per  quarter. 

(2)  The  income  cannot  be  reasonably  anticipated. 

(b)  Earned  income  not  exceeding  $30  per  calendar  quarter  shall  be  ex- 
empt if  either  of  the  following  conditions  are  met: 

(1)  The  income  is  received  not  more  than  twice  per  quarter. 

(2)  The  income  cannot  be  reasonably  anticipated. 

NOTE:  Authority  cited:  Secfions  10725  and  14124.5,  Welfare  and  Insfitufions 
Code.  Reference:  Secfions  14005.4  and  14005.7,  Welfare  and  Institufions  Code. 

History 

1.  Amendment  filed  12-1 5-77;  effecfive  thirtieth  day  thereafter  (Register  77,  No. 
51). 

2.  Editorial  correcfion  adding  NOTE  filed  6-10-83  (Register  83,  No.  24). 

§  50543.    Student  Exemption. 

(a)  All  earned  income,  including  earnings  from  JTPA  after  the  six 
months'  exemption  pursuant  to  Section  50539  has  expired,  of  an  AFDC- 
MN  or  MI  child  shall  be  exempt  if  the  child  is  either  of  the  following: 

(1)  A  full-time  student. 

(2)  A  part-time  student  with  a  school  schedule  that  is  equal  to  at  least 
one-half  of  a  full-time  curriculum,  and  the  child  is  not  employed  full- 
time. 

(b)  For  purposes  of  this  exemption  the  following  definitions  apply: 
(1)  School  attendance  means  enrollment  and  attendance  in  a  school, 

college,  university,  or  in  a  course  of  vocational  or  technical  training  de- 


Page  367 


Register  93,  No.  41;  10-8-93 


§  50543.5 


BARCLAYS  CALIFORNIA  CODE  OF  REGULATIONS 


Title  22 


signed  to  fit  the  child  for  gainful  employment  and  includes  participation 
in  the  Job  Corps  program  under  the  Economic  Opportunity  Act. 

(2)